1
|
Calabrese F, Pasta A, Bodini G, Furnari M, Zentilin P, Giannini EG, Maniero D, Casa DD, Cataudella G, Frazzoni M, Penagini R, Elena A, De Bortoli N, Visaggi P, Savarino V, Savarino E, Marabotto E. Editorial: Diagnosis of GERD in patients with extra-oesophageal symptoms-still a long way to go… Authors' reply'. Aliment Pharmacol Ther 2024; 59:1150-1151. [PMID: 38591806 DOI: 10.1111/apt.17960] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
LINKED CONTENTThis article is linked to Calabrese et al papers. To view these articles, visit https://doi.org/10.1111/apt.17934 and https://doi.org/10.1111/apt.17955
Collapse
Affiliation(s)
- Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Patrizia Zentilin
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Daria Maniero
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Domenico Della Casa
- Department of Surgical-Surgery Endoscopy, Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi, Milan, Italy
| | - Arsiè Elena
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi, Milan, Italy
| | - Nicola De Bortoli
- Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pierfrancesco Visaggi
- Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| |
Collapse
|
2
|
Calabrese F, Pasta A, Bodini G, Furnari M, Zentilin P, Giannini EG, Maniero D, Della Casa D, Cataudella G, Frazzoni M, Penagini R, Elena A, de Bortoli N, Visaggi P, Savarino V, Savarino E, Marabotto E. Applying Lyon consensus criteria in the work-up of patients with extra-oesophageal symptoms - A multicentre retrospective study. Aliment Pharmacol Ther 2024; 59:1134-1143. [PMID: 38445690 DOI: 10.1111/apt.17934] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The diagnosis of gastro-oesophageal reflux disease (GERD) based on otolaryngologist's assessment of laryngoscopic findings remains contentious in terms of sensitivity and specificity. AIMS To evaluate GERD prevalence, applying Lyon 2.0 Consensus criteria, in patients with extra-oesophageal symptoms undergoing laryngoscopic examination and impedance-pH monitoring. METHODS In this retrospective assessment, we included 470 patients with extra-oesophageal symptoms, either isolated or combined with typical symptoms, who had been referred to six tertiary Italian Gastroenterology Units between January and December 2020. Of these, 274 underwent 24-h impedance-pH monitoring and laryngoscopy off PPI therapy. GERD diagnosis followed Lyon Consensus 2.0 criteria, incorporating mean nocturnal baseline impedance when pH-impedance monitoring was inconclusive. RESULTS Laryngoscopic examination revealed pathological findings (predominantly posterior laryngitis) in 71.2% (195/274). GERD was diagnosed in 29.2% (80/274) via impedance-pH monitoring. The prevalence of GERD in patients with positive or negative laryngoscopy was similar (32.3% vs. 21.5%, p = 0.075). No significant difference in proximal reflux occurrences was noted between positive and negative laryngoscopy groups (33.3% vs. 24.1%, p = 0.133). Laryngoscopy demonstrated sensitivity and specificity of 78.8% and 32.0%, respectively, with a positive predictive value (PPV) of 32.3% and negative predictive value (NPV) of 28.4%. In contrast, a threshold of four concurrent laryngoscopic signs, identified in only eight patients, demonstrated a PPV of 93.8% and a NPV of 73.6% (sensitivity 25.4%, specificity 99.2%). CONCLUSION This study underscores the limited diagnostic accuracy of laryngoscopy, emphasising the necessity of impedance-pH monitoring for confirming GERD diagnoses using Lyon 2.0 criteria in patients with suspected extra-oesophageal symptoms.
Collapse
Affiliation(s)
- Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Patrizia Zentilin
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Daria Maniero
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Domenico Della Casa
- Department of Surgical-Surgery Endoscopy, Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi, Milan, Italy
| | - Arsiè Elena
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi, Milan, Italy
| | - Nicola de Bortoli
- Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pierfrancesco Visaggi
- Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| |
Collapse
|
3
|
Labanca S, Pasta A, Cariati S, Calabrese F, Pieri G, Plaz Torres MC, Marenco S, Giannini EG. Letter to the Editor: Is CAD-LT score as a predictor of coronary artery disease following liver transplantation? Liver Transpl 2024; 30:E28-E29. [PMID: 38100206 DOI: 10.1097/lvt.0000000000000315] [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] [Received: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Sara Labanca
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Sara Cariati
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Pieri
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Marenco
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
4
|
Barbera L, Pasta A, Calabrese F, Zentilin P, Fragale M, Barbieri M, Peretti G, Savarino EV, Giannini EG, Marabotto E. Evaluation of the pathophysiological association between the GERD and OSAS: Esophageal pH-monitoring results beyond Lyon criteria. J Gastroenterol Hepatol 2024; 39:772. [PMID: 38221800 DOI: 10.1111/jgh.16488] [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] [Received: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Affiliation(s)
- L Barbera
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - A Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - F Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - P Zentilin
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Fragale
- Unit of Otolaryngology, ASL 4 Liguria, Hospital of Lavagna, Genoa, Italy
| | - M Barbieri
- Unit of Otolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Peretti
- Unit of Otolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - E V Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Padua, Italy
| | - E G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - E Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
5
|
Pasta A, Pieri G, Plaz Torres MC, Trevisani F, Giannini EG. Hepatocellular carcinoma in patients with Autoimmune Hepatitis. J Hepatol 2024:S0168-8278(24)00208-3. [PMID: 38527525 DOI: 10.1016/j.jhep.2024.03.025] [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] [Received: 02/26/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Giulia Pieri
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy;; Gastroenterology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy;; Gastroenterology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Franco Trevisani
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna, Bologna, Italy;; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy;; Gastroenterology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;.
| |
Collapse
|
6
|
Pasta A, Pelizzaro F, Marabotto E, Calabrese F, Formisano E, Djahandideh Sheijani S, Brandimarte G, Manes G, Gravina AG, Savarino EV. Patient journey in gastroesophageal reflux disease: real-world perspectives from Italian gastroenterologists, primary care physicians, and ENT specialists. Therap Adv Gastroenterol 2024; 17:17562848241239590. [PMID: 38524789 PMCID: PMC10960349 DOI: 10.1177/17562848241239590] [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: 12/21/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
Background Gastroesophageal reflux disease (GERD) is a challenging condition that involves different physicians, such as general practitioners (GPs), gastroenterologists, and ears, nose and throat (ENT) specialists. A common approach consists of proton-pump inhibitors (PPIs) administration. Adjunctive pharmacological treatment may have a role in the management of non-responders to PPIs. Objectives We aimed to survey GPs and different medical specialists to investigate the medical approaches to patients reporting GERD symptoms. In addition, we examined the use of adjunctive pharmacological treatments in patients with GERD symptoms who do not respond to PPIs. Design Retrospective observational study. Methods A survey was conducted among a large sample of gastroenterologists, GPs, and ENT specialists. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life were explored with the GERD Impact Scale and with Reflux Symptom Index (RSI). All therapies administered usually for GERD were investigated. Results A total of 6211 patients were analyzed in this survey. Patients with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p < 0.0001). The GSI was higher in patients followed by gastroenterologists (9 points) and GPs (9 points) than ENT specialists (8 points), but the RSI was higher in the ENT group (14.3 ± 6.93) than in GPs and gastroenterologist groups (10.36 ± 6.36 and 10.81 ± 7.30, p < 0.0001). Chest pain had the highest negative impact on quality of life (p < 0.0001). Of the 3025 patients who used PPIs, non-responders showed a lower GSI when treated with a combination of adjunctive pharmacological treatments and bioadhesive compounds, than with single-component drugs. Conclusion Patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.
Collapse
Affiliation(s)
- Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padova, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Elena Formisano
- Nutritional Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Giampiero Manes
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Antonietta Gerarda Gravina
- Gastroenterology Unit, Department of Precision Medicine, University of Campania ‘Luigi Vanvitell’, Naples, Italy
- Andrea Pasta; Elisa Marabotto; Francesco Calabrese; Shirin Djahandideh Sheijaniare also affiliated to IRCCS, Policlinico San Martino, Genoa, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, via Giustiniani 2, Padua 35128, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padova, Italy
| |
Collapse
|
7
|
Giannini EG, Pasta A, Pieri G, Plaz Torres MC, Marseglia M, Pelizzaro F, Sangiovanni A, Cabibbo G, Ghittoni G, Di Marco M, Foschi FG, Guarino M, Biasini E, Saitta C, Campani C, Svegliati-Baroni G, Gasbarrini A, Brunetto MR, Magalotti D, Azzaroli F, Mega A, Sacco R, Nardone G, Sacerdoti D, Masotto A, Vidili G, Bucci L, Vitale A, Trevisani F. Characteristics and outcome of anti-hepatitis D virus positive patients with hepatocellular carcinoma. Liver Int 2024. [PMID: 38426262 DOI: 10.1111/liv.15855] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND & AIMS Chronic hepatitis D virus (HDV) often leads to end-stage liver disease and hepatocellular carcinoma (HCC). Comprehensive data pertaining to large populations with HDV and HCC are missing, therefore we sought to assess the characteristics, management, and outcome of these patients, comparing them to patients with hepatitis B virus (HBV) infection. METHODS We analysed the Italian Liver Cancer database focusing on patients with positivity for HBV surface antigen and anti-HDV antibodies (HBV/HDV, n = 107) and patients with HBV infection alone (n = 588). Clinical and oncological characteristics, treatment, and survival were compared in the two groups. RESULTS Patients with HBV/HDV had worse liver function [Model for End-stage Liver Disease score: 11 vs. 9, p < .0001; Child-Turcotte-Pugh score: 7 vs. 5, p < .0001] than patients with HBV. HCC was more frequently diagnosed during surveillance (72.9% vs. 52.4%, p = .0002), and the oncological stage was more frequently Milan-in (67.3% vs. 52.7%, p = .005) in patients with HBV/HDV. Liver transplantation was more frequently performed in HBV/HDV than in HBV patients (36.4% vs. 9.5%), while the opposite was observed for resection (8.4% vs. 20.1%, p < .0001), and in a competing risk analysis, HBV/HDV patients had a higher probability of receiving transplantation, independently of liver function and oncological stage. A trend towards longer survival was observed in patients with HBV/HDV (50.4 vs. 44.4 months, p = .106). CONCLUSIONS In patients with HBV/HDV, HCC is diagnosed more frequently during surveillance, resulting in a less advanced cancer stage in patients with more deranged liver function than HBV alone. Patients with HBV/HDV have a heightened benefit from liver transplantation, positively influencing survival.
Collapse
Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Pieri
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mariarosaria Marseglia
- Division of Internal Medicine, Hepatobiliary Diseases and Immunoallergology, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Padua, Italy
| | - Angelo Sangiovanni
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale maggiore Policlinico and C.R.C. "A.M. & A. Migliavacca Center for Liver Disease", Milan, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | | | | | | | - Maria Guarino
- Department of Clinical Medicine and Surgery, Diseases of the Liver and Biliary System Unit, University of Naples "Federico II", Naples, Italy
| | - Elisabetta Biasini
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Carlo Saitta
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Florence, Florence, Italy
| | | | - Antonio Gasbarrini
- Liver Unit, CEMAD - Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory, University Hospital of Pisa, Pisa, Italy
| | - Donatella Magalotti
- Division of Internal Medicine, Neurovascular and Hepatometabolic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Naples "Federico II", Naples, Italy
| | - David Sacerdoti
- Liver Unit, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Laura Bucci
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna, Bologna, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Franco Trevisani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna, Bologna, Italy
| |
Collapse
|
8
|
Pasta A, Calabrese F, Djahandideh Sheijani S, Furnari M, Giannini EG, Grillo F, Marabotto E, Mastracci L, Murdaca G, Negrini S, Savarino EV, Savarino V, Zentilin P. Expression of epidermal growth factor receptor (EGFR) in systemic sclerosis patients (SSc) and gastro-oesophageal reflux disease (GORD). Immunol Lett 2024; 265:31-36. [PMID: 38171474 DOI: 10.1016/j.imlet.2023.106834] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/15/2023] [Accepted: 12/30/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Systemic sclerosis (SSc) affects the connective tissue and leads to an abnormal fibrotic process in the skin and internal organs. Epidermal Growth Factor Receptor (EGFR) is able to induce cell proliferation and differentiation, and its expression is increased in SSc patients with pulmonary artery hypertension and in skin biopsies in patients with scleroderma. To date, no data on esophageal expression of EGFR are available in SSc patients. We aimed to evaluate whether the pro-fibrogenic pathways of SSc may affect EGFR expression in the esophagus. METHODS A retrospective analysis included patients with SSc and control subjects suffering from gastroesophageal reflux symptoms. Endoscopic assessment and histopathologic analyses were performed in all subjects and the presence of microscopic esophagitis was used to distinguish patients with normal esophageal mucosa and subjects with non-erosive reflux disease. EGFR expression was measured in all subjects. RESULTS A total of 35 patients with SSc were included, while the control group included 67 non-SSc patients. EGFR expression at the Z-line was higher in SSc patients than non-SSc patients in absence of microscopic esophagitis (median 65 %, IQR 56-71 % vs 42 %, IQR 37-54 %, p < 0.001). Microscopic esophagitis was found in 60 % of patients with SSc and 62.7 % of control patients, and EGFR expression was significantly higher in patients presenting microscopic esophagitis both in SSc and non-SSc patients. CONCLUSION The EGFR hyperexpression may be due to SSc and/or reflux-related damage in patients with microscopic esophagitis. Further studies are warranted to answer open questions and provide a possible role of EGFR in terms of diagnosis, prognosis, and therapy.
Collapse
Affiliation(s)
- Andrea Pasta
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy
| | - Francesco Calabrese
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy
| | | | - Manuele Furnari
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy
| | - Federica Grillo
- Department of Surgical Sciences and Integrated Diagnostics, Pathological Anatomy Unit, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Marabotto
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy
| | - Luca Mastracci
- Department of Surgical Sciences and Integrated Diagnostics, Pathological Anatomy Unit, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, Internal Medicine Unit, University of Genoa, Genoa, Italy
| | - Simone Negrini
- Department of Internal Medicine, Clinical Immunology and Translational Medicine Unit, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology Unit, Azienda Ospedale Università Padova, Padua, Italy
| | - Vincenzo Savarino
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy
| | - Patrizia Zentilin
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy.
| |
Collapse
|
9
|
Pasta A, Formisano E, Calabrese F, Plaz Torres MC, Bodini G, Marabotto E, Pisciotta L, Giannini EG, Furnari M. Food Intolerances, Food Allergies and IBS: Lights and Shadows. Nutrients 2024; 16:265. [PMID: 38257158 PMCID: PMC10821155 DOI: 10.3390/nu16020265] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
This narrative review delves into the intricate relationship between irritable bowel syndrome (IBS) and food intolerances. IBS, a chronic functional gastrointestinal disorder, is characterized by symptoms like abdominal pain and altered bowel habits. The prevalence of IBS has increased globally, especially among young adults. Food and dietary habits play a crucial role in IBS management. About 85-90% of IBS patients report symptom exacerbation linked to specific food consumption, highlighting the strong connection between food intolerances and IBS. Food intolerances often exhibit a dose-dependent pattern, posing a challenge in identifying trigger foods. This issue is further complicated by the complex nature of gastrointestinal physiology and varying food compositions. This review discusses various dietary patterns and their impact on IBS, including the low-FODMAP diet, gluten-free diet, and Mediterranean diet. It highlights the importance of a personalized approach in dietary management, considering individual symptom variability and dietary history. In conclusion, this review emphasizes the need for accurate diagnosis and holistic management of IBS, considering the complex interplay between dietary factors and gastrointestinal pathophysiology. It underlines the importance of patient education and adherence to treatment plans, acknowledging the challenges posed by the variability in dietary triggers and the psychological impact of dietary restrictions.
Collapse
Affiliation(s)
- Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (A.P.); (F.C.); (M.C.P.T.); (G.B.); (E.M.); (E.G.G.)
| | - Elena Formisano
- Dietetics and Clinical Nutrition Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (E.F.); (L.P.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (A.P.); (F.C.); (M.C.P.T.); (G.B.); (E.M.); (E.G.G.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (A.P.); (F.C.); (M.C.P.T.); (G.B.); (E.M.); (E.G.G.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (A.P.); (F.C.); (M.C.P.T.); (G.B.); (E.M.); (E.G.G.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (A.P.); (F.C.); (M.C.P.T.); (G.B.); (E.M.); (E.G.G.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Livia Pisciotta
- Dietetics and Clinical Nutrition Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (E.F.); (L.P.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (A.P.); (F.C.); (M.C.P.T.); (G.B.); (E.M.); (E.G.G.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (A.P.); (F.C.); (M.C.P.T.); (G.B.); (E.M.); (E.G.G.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| |
Collapse
|
10
|
Marabotto E, Pasta A, Calabrese F, Bodini G, Furnari M, Giannini EG, Savarino E. Is global score better than a single histological parameter for assessing microscopic esophagitis? Neurogastroenterol Motil 2024; 36:e14685. [PMID: 37793137 DOI: 10.1111/nmo.14685] [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] [Received: 09/04/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Elisa Marabotto
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Calabrese
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgia Bodini
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Manuele Furnari
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo Giovanni Giannini
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| |
Collapse
|
11
|
Tursi A, Mocci G, Scaldaferri F, Napolitano D, Maresca R, Pugliese D, Semprucci G, Savarino E, Cuomo A, Donnarumma L, Bodini G, Pasta A, Maconi G, Cataletti G, Pranzo G, Rodinò S, Sebkova L, Costa F, Ferronato A, Gaiani F, Marzo M, Luppino I, Fabiano G, Paese P, Elisei W, Monterubbianesi R, Faggiani R, Grossi L, Serio M, Scarcelli A, Lorenzetti R, Allegretta L, Chiri S, Grasso G, Antonelli E, Bassotti G, Spagnuolo R, Luzza F, Fanigliulo L, Rocco G, Sacchi C, Zampaletta C, Rocchi C, Bolognini L, Bendia E, Bianco MA, Capone P, Meucci C, Colucci R, Tonti P, Neve V, Della Valle N, Felice C, Pica R, Cocco A, Forti G, Onidi FM, Usai Satta P, Checchin D, Gravina AG, Pellegrino R, Picchio M, Papa A. Ustekinumab safety and effectiveness in patients with ulcerative colitis: results from a large real-life study. Expert Opin Biol Ther 2024; 24:101-109. [PMID: 38250818 DOI: 10.1080/14712598.2024.2309300] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/19/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Ustekinumab (UST) is an interleukin-12/interleukin-23 receptor antagonist recently approved for treating ulcerative colitis (UC) but with limited real-world data. Therefore, we evaluated the effectiveness and safety of UST in patients with UC in a real-world setting. RESEARCH DESIGN AND METHODS This is a multicenter, retrospective, observational cohort study. The primary endpoints were the clinical remission rate (partial Mayo score, PMS, ≤1) and the safety of UST. Other endpoints were corticosteroid-free remission (CSFR) rate, clinical response rate (PMS reduction of at least 2 points), and fecal calprotectin (FC) reduction at week 24. RESULTS We included 256 consecutive patients with UC (M/F 139/117, median age 52). The clinical remission and clinical response rates at eight weeks were 18.7% (44/235) and 53.2% (125/235), respectively, and 27.6% (42/152) and 61.8% (94/152) at 24 weeks, respectively. At 24 weeks, CSFR was 20.3% (31/152), and FC significantly dropped at week 12 (p = 0.0004) and 24 (p = 0.038). At eight weeks, patients naïve or with one previous biologic treatment showed higher remission (p = 0.002) and clinical >response rates (p = 0.018) than patients previously treated with ≥ 2. Adverse events occurred in six patients (2.3%), whereas four patients (1.6%) underwent colectomy. CONCLUSION This real-world study shows that UST effectively and safely treats patients with UC.
Collapse
Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria, Italy
- Department of Medical and Surgical Sciences, Catholic University, Rome, Italy
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari, Italy
| | - Franco Scaldaferri
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
- School of Medicine, Catholic University, Rome, Italy
| | - Daniele Napolitano
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
| | - Rossella Maresca
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
| | - Daniela Pugliese
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
- School of Medicine, Catholic University, Rome, Italy
| | - Gianluca Semprucci
- Gastroenterology Unit, Azienda Ospedale-Università di Padova (AOUP), Padua, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale-Università di Padova (AOUP), Padua, Italy
| | - Antonio Cuomo
- Division of Gastroenterology, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Laura Donnarumma
- Division of Gastroenterology, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Giorgia Bodini
- Department of Internal Medicine and Medical Specialties, Division of Gastroenterology, IRCCS "San Martino" Hospital, University of Genoa, Genoa, Italy
| | - Andrea Pasta
- Department of Internal Medicine and Medical Specialties, Division of Gastroenterology, IRCCS "San Martino" Hospital, University of Genoa, Genoa, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Milan, Italy
| | - Giovanni Cataletti
- Gastroenterology Unit, Department Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Milan, Italy
| | - Giuseppe Pranzo
- Ambulatory for IBD Treatment, "Valle D'Itria" Hospital, Martina Franca (TA), Italy
| | - Stefano Rodinò
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro, Italy
| | - Ladislava Sebkova
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro, Italy
| | - Francesco Costa
- IBD Unit, Department of General Surgery and Gastroenterology, Pisa University Hospital, Pisa, Italy
| | - Antonio Ferronato
- Digestive Endoscopy Unit, Hospital of Santorso, ULSS7, Santorso (VI), Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Manuela Marzo
- Division of Gastroenterology, "Veris-Delli Ponti" Hospital, Scorrano (LE), Italy
| | - Ileana Luppino
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Giulia Fabiano
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Pietro Paese
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Walter Elisei
- Division of Gastroenterology, A.O. "S. Camillo-Folanini", Rome, Italy
| | | | - Roberto Faggiani
- Division of Gastroenterology, A.O. "S. Camillo-Folanini", Rome, Italy
| | - Laurino Grossi
- Gastroenterology Unit, "Spirito Santo" Hospital, "G d'Annunzio" University, Pescara, Italy
| | - Mariaelena Serio
- Division of Gastroenterology, "San Salvatore" Hospital, Pesaro, Italy
| | | | - Roberto Lorenzetti
- Division of Gastroenterology, "Nuovo Regina Margherita" Territorial Hospital, Roma, Italy
| | - Leonardo Allegretta
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | - Stefania Chiri
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | - Giuseppina Grasso
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | - Elisabetta Antonelli
- Gastroenterology and Hepatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabrio Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rocco Spagnuolo
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Libera Fanigliulo
- Division of Gastroenterology, "S.S. Annunziata" Hospital, Taranto, Italy
| | - Giulia Rocco
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo, Italy
| | - Carlotta Sacchi
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo, Italy
| | | | - Chiara Rocchi
- Division of Gastroenterology and Digestive Endoscopy, "Mater Olbia" Hospital, Olbia (SS), Italy
| | - Laura Bolognini
- Division of Digestive Diseases, Digestive Endoscopy and Inflammatory Bowel Diseases, A.O. "Ospedali Riuniti", Ancona, Italy
| | - Emanuele Bendia
- Division of Digestive Diseases, Digestive Endoscopy and Inflammatory Bowel Diseases, A.O. "Ospedali Riuniti", Ancona, Italy
| | - Maria Antonia Bianco
- Division of Gastroenterology, "T. Maresca" Hospital, Torre del Greco (NA), Italy
| | - Pietro Capone
- Division of Gastroenterology, "T. Maresca" Hospital, Torre del Greco (NA), Italy
| | - Costantino Meucci
- Division of Gastroenterology, "T. Maresca" Hospital, Torre del Greco (NA), Italy
| | - Raffaele Colucci
- Digestive Endoscopy Unit, "San Matteo degli Infermi" Hospital, Spoleto (PG), Italy
| | - Paolo Tonti
- Division of Gastroenterology, "A. Perrino" Hospital, Brindisi, Italy
| | - Viviana Neve
- Division of Gastroenterology, "A. Perrino" Hospital, Brindisi, Italy
| | | | - Carla Felice
- Division of Internal Medicine, "Ca' Foncello" University Hospital, Treviso, Italy
| | - Roberta Pica
- Division of Gastroenterology, IBD Unit, "S. Pertini" Hospital, Rome, Italy
| | - Andrea Cocco
- Division of Gastroenterology, IBD Unit, "S. Pertini" Hospital, Rome, Italy
| | - Giacomo Forti
- Division of Digestive Endoscopy, "S. Maria Goretti" Hospital, Latina, Italy
| | | | | | - Davide Checchin
- Division of Gastroenterology, " S Giovanni e Paolo" Hospital, Mestre - Venezia, Italy
| | - Antonietta Gerarda Gravina
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaele Pellegrino
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Picchio
- Division of General Surgery, "P. Colombo" Hospital, ASL Roma 6, Velletri (Roma), Italy
| | - Alfredo Papa
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
- School of Medicine, Catholic University, Rome, Italy
| |
Collapse
|
12
|
Bodini G, Ghezzi A, Pasta A, Marabotto E, Calabrese F, Facchini C, Demarzo MG, Giannini EG. Reduction of Fecal Calprotectin Levels Induced by a Short Course of Escherichia Coli Nissle is Associated with a Lower Likelihood of Disease Flares in Patients with Ulcerative Colitis in Clinical Remission. J Gastrointestin Liver Dis 2023; 32:438-443. [PMID: 38147604 DOI: 10.15403/jgld-4932] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/21/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS Fecal calprotectin (FC) is a biomarker of gut inflammation, and Escherichia coli Nissle 1917 (EcN) is a probiotic strain able to reduce gut inflammation and maintain disease remission in patients with inflammatory bowel disease (IBD). The aim is to assess the effects of EcN administration in patients with IBD in clinical remission and altered FC values. METHODS We prospectively included 82 patients with ulcerative colitis (UC) (n=49) and Crohn's disease (CD) (n=33) in clinical remission and with FC values above 250 mcg/g (T0) who were treated with EcN alone for 2 months. FC values were assessed at the end of EcN treatment (T1) and clinical disease activity at 3 months (T2). RESULTS At T1 median FC values were significantly lower compared to T0 both in patients with CD (312 mcg/g vs 626 mcg/g, p<0.0001) and UC (100 mcg/g vs 584 mcg/g; p<0.0001). Patients with UC who experienced disease relapse at T2 had lesser reduction in median FC values at T1 (-229 mcg/g, vs -397 mcg/g, p=0.049), while in patients with CD we observed no statistically significant difference (-358 mcg/g, vs -427; p=0.568). In patients with UC, a reduction of at least 532 mcg/g in FC had an accuracy of 69.7% and a positive predictive value of 65.7% in predicting maintenance of remission. CONCLUSIONS A short course of EcN was associated with a reduction of FC values in patients with IBD in clinical remission and baseline altered FC values, and in patients with UC this decrease was associated with maintenance of clinical remission.
Collapse
Affiliation(s)
- Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Andrea Ghezzi
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Chiara Facchini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Maria Giulia Demarzo
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| |
Collapse
|
13
|
Pasta A, Calabrese F, Plaz Torres MC, Bodini G, Furnari M, Savarino EV, Savarino V, Giannini EG, Marabotto E. Albumin-bilirubin score in non-malignant liver diseases should be properly validated. World J Gastroenterol 2023; 29:6089-6091. [PMID: 38130741 PMCID: PMC10731160 DOI: 10.3748/wjg.v29.i46.6089] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 12/13/2023] Open
Abstract
The albumin-bilirubin (ALBI) score to assess the risk of decompensation in patients with initially compensated cirrhosis may improve their prognostic evaluation. This letter critically evaluates the research, which utilizes the ALBI score to forecast decompensation in cirrhosis patients over a three-year period. This score was initially developed to assess liver function in hepatocellular carcinoma, its prognostic utility for non-malignant liver diseases has now been explored, recognizing decompensation as a pivotal event that significantly affects patient's survival. Some concerns regarding the methodology of this research may be raised, particularly the exclusive use of radiological diagnosis, potentially including patients without definite cirrhosis and thus skewing the decompensation risk assessment. The reported predominance of variceal bleeding as a decompensating event conflicts with established literature, that often reports ascites as the initial decompensation manifestation. The letter highlights the absence of details on esophageal varices and their management, which could introduce bias in evaluating the ALBI score's predictive power. Furthermore, the letter points out the small sample size of patients with high-risk ALBI grades, potentially compromising the score's validity in this context. We suggest prospective future research to investigate the dynamic changes in the ALBI score over time to reinforce the validity of the ALBI score as a predictor of decompensation in non-malignant liver disease.
Collapse
Affiliation(s)
- Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua 35128, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Italy
| |
Collapse
|
14
|
Marten Canavesio Y, Pasta A, Calabrese F, Alessandri E, Cutolo M, Paolino S, Pizzorni C, Sulli A, Savarino V, Giannini EG, Zentilin P, Bodini G, Furnari M, Savarino E, Marabotto E. Association between esophageal motor disorders and pulmonary involvement in patients affected by systemic sclerosis: a retrospective study. Rheumatol Int 2023:10.1007/s00296-023-05399-y. [PMID: 37542603 DOI: 10.1007/s00296-023-05399-y] [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: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 08/07/2023]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease of the connective tissue that can affect multiple organs. The esophagus is the most affected gastrointestinal tract, while interstitial lung disease (ILD) is a main feature associated with SSc. The aim of the present study was to evaluate the association and prognostic implication between motor esophageal disorders and pulmonary involvement in SSc patients. We retrospectively assessed patients with SSc who underwent both the HRM with the new Chicago Classification 4.0 and pulmonary evaluation comprehensive of function tests and high-resolution computer tomography (HrCT) with the use of Warrick score. A total score ≥ 7 was considered predictive of ILD, while a score ≥ 10 in a HrCT acquired prospectively from baseline evaluation was considered to establish significant interstitial involvement. Forty-two patients were included. We found a score ≥ 7 in 11 patients with aperistalsis, in 6 subjects with IEM and in 6 patients with a normal manometry. Otherwise, a score < 7 was observed in 3 patients with aperistalsis, and in 2 and 14 patients with IEM and with a normal contractility, respectively. Higher scores were observed in subjects with absent contractility or ineffective esophageal motility than subjects with normal motility, indeed DCI and HrCT score were inversely correlated in linear and logarithmic regression analysis. Prospectively, lower baseline LESP and greater HrCT scores at follow-up evaluation were significantly correlated. This study shows an association between motor esophageal disorder and pulmonary involvement in SSc patients: more severe is the esophageal involvement, more critical is the pulmonary disease.
Collapse
Affiliation(s)
- Ylenia Marten Canavesio
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Elisa Alessandri
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Patrizia Zentilin
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padua, Padua, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| |
Collapse
|
15
|
Djahandideh Sheijani S, Calabrese F, Pasta A, Marabotto E, Bodini G, Furnari M, Grillo F, Mastracci L, Savarino EV, Savarino V, Giannini EG. Clopidogrel-Induced Eosinophilic Colitis. ACG Case Rep J 2023; 10:e01118. [PMID: 37547482 PMCID: PMC10400044 DOI: 10.14309/crj.0000000000001118] [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: 05/11/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Eosinophilic colitis is a rare condition characterized by histologic findings of high eosinophilic infiltrate in the gut wall, typically presenting with diarrhea and abdominal pain. The etiology of this entity remains unclear because it can be primary or can occur secondarily to infections, drugs, or even in association with immune-mediated diseases. We present the case of a woman referred to our outpatient clinic for chronic diarrhea that had been worsening for months. Colonoscopy with biopsies was performed, and eosinophilic colitis associated with the use of clopidogrel was diagnosed. After clopidogrel discontinuation, a complete remission of the clinical and histological picture was observed.
Collapse
Affiliation(s)
- Shirin Djahandideh Sheijani
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Grillo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, Pathological Anatomy Unit, University of Genoa, Genoa, Italy
| | - Luca Mastracci
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, Pathological Anatomy Unit, University of Genoa, Genoa, Italy
| | - Edoardo V. Savarino
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università Padova, Padua, Italy
| | | | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
16
|
Pasta A, Calabrese F, Giannini EG. Assessing the Short-Term Prognosis of Patients with Cirrhosis Using the DIC Scores. Thromb Haemost 2023; 123:744-746. [PMID: 36808405 DOI: 10.1055/a-2039-1575] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
17
|
Pasta A, Calabrese F, Labanca S, Marenco S, Pieri G, Plaz Torres MC, Intagliata NM, Caldwell SH, Giannini EG. Safety and efficacy of venous thromboembolism prophylaxis in patients with cirrhosis: A systematic review and meta-analysis. Liver Int 2023. [PMID: 37249027 DOI: 10.1111/liv.15609] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND & AIMS Patients with cirrhosis are considered in a haemostatic balance, though weaker than in normal subjects. In these patients, however, the use of pharmacological prophylaxis for venous thromboembolism (VTE) remains controversial. Therefore, in this study, we aimed to assess the safety and efficacy of VTE prophylaxis in patients with cirrhosis. METHODS We conducted a systematic review of studies reporting the occurrence of bleeding and VTE events in patients with cirrhosis, and controls, undergoing VTE prophylaxis. Meta-regression analysis was conducted to further explore the determinants of heterogeneity in the study of the occurrence of either bleeding or VTE events. RESULTS In a total of 10 studies, including 5712 patients, of which 2330 undergoing VTE prophylaxis, bleeding (n = 5513) and VTE events occurred in 8.2% and 2.8% patients respectively. A total of 2963 and 3162 patients were included from low-risk of bias studies in bleeding and VTE analysis respectively: while administration of VTE prophylaxis did not seem to reduce VTE (OR = 1.07, CI 0.39-2.96, p = .89), importantly prophylaxis was not associated with increased bleeding risk (OR = 0.56, CI 0.20-1.59, p = .27). Meta-regression analysis showed that no parameter significantly influenced the heterogeneity of data regarding bleeding or VTE events. CONCLUSIONS In patients with cirrhosis, current evidence is insufficient to advise for or against the use of VTE prophylaxis, mainly due to lack of quality and homogeneity of available data. However, its use does not appear to be associated with a significant bleeding risk. Adequately designed studies are required to provide a measure of its overall utility.
Collapse
Affiliation(s)
- Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Labanca
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Marenco
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Pieri
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicolas M Intagliata
- Division of Gastroenterology and Hepatology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Stephen H Caldwell
- Division of Gastroenterology and Hepatology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
18
|
Kayali S, Pasta A, Plaz Torres MC, Jaffe A, Strazzabosco M, Marenco S, Giannini EG. Immune checkpoint inhibitors in malignancies after liver transplantation: A systematic review and pooled analysis. Liver Int 2023; 43:8-17. [PMID: 36102312 PMCID: PMC10087158 DOI: 10.1111/liv.15419] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/13/2022] [Accepted: 09/06/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Treatment of de novo malignancies and recurrent hepatocellular carcinoma with immune checkpoint inhibitors (ICI) in liver transplant recipients (LT) is an attractive strategy that is infrequently pursued because of the lack of strong evidence regarding their safety and efficacy. In this systematic review with pooled analysis, we aimed to assess safety and efficacy of ICI therapy following LT. METHODS We performed a systematic search of case reports and series published until January 2022. We included 31 publications reporting a total of 52 patients treated with ICIs after LT and assessed in a pooled analysis the risk of graft rejection and the outcome of ICI therapy. RESULTS Acute graft rejection occurred in 15 patients (28.8%) and 7 patients (13.4% of the total cohort) died because of graft loss. Rejection was associated with shorter overall survival (OS) (17.2 months, confidence interval [CI] 12.1-22.2 vs. 3.5 months, CI 1.6-5.4, p < 0.001). Disease control rate was 44.2% (n = 23), and in these patients, OS was longer than in non-responders (26.4 months, CI 20.8-32.0 vs. 3.4 months, CI 2.1-4.7, p < 0.001). CONCLUSIONS Observational, off-label experience suggests that treatment with ICI for advanced malignancies in LT recipients might not be discarded a priori. This notwithstanding, ICI treatment in these patients is associated with a substantial risk of graft rejection and mortality. Prospective studies are needed to provide adequate safety and efficacy figures of ICI treatment in this fragile population.
Collapse
Affiliation(s)
- Stefano Kayali
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Ariel Jaffe
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Smilow Cancer Hospital and Liver Cancer Program, New Haven, Connecticut, USA
| | - Mario Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Smilow Cancer Hospital and Liver Cancer Program, New Haven, Connecticut, USA
| | - Simona Marenco
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| |
Collapse
|
19
|
Cremonini AL, Pasta A, Carbone F, Visconti L, Casula M, Elia E, Bonaventura A, Liberale L, Bertolotto M, Artom N, Minetti S, Contini P, Verzola D, Pontremoli R, Viazzi F, Viviani GL, Bertolini S, Pende A, Montecucco F, Pisciotta L. Lipoprotein(a) Modulates Carotid Atherosclerosis in Metabolic Syndrome. Front Mol Biosci 2022; 9:854624. [PMID: 35755826 PMCID: PMC9214261 DOI: 10.3389/fmolb.2022.854624] [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] [Received: 01/14/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Aim: High lipoprotein(a) [Lp(a)] is a well-established cardiovascular (CV) risk factor, but the effect of mildly elevated Lp(a) on CV health is largely unknown. Our aim was to evaluate if Lp(a) is associated with the severity of carotid atherosclerosis (CA) in the specific subset of metabolic syndrome (MetS). Patients and Methods: Subjects with diagnosed MetS and ultrasound-assessed CA were enrolled. Those patients were categorized according to the severity of CA (moderate vs. severe), and the circulating levels of Lp(a) alongside with clinical, anthropometric, and biochemical data were collected. Results: Sixty-five patients were finally included: twenty-five with moderate and forty with severe CA (all with asymptomatic disease). Intergroup comparison showed Lp(a) as the only significantly different variable [6 (2–12) mg/dl vs. 11.5 (6–29.5) mg/dl; p = 0.018]. Circulating levels of Lp(a) were also confirmed as the only variable independently associated with severity of CA at logistic regression analysis [OR 2.9 (95% CI 1.1–7.8); p = 0.040]. ROC curve analysis for Lp(a) confirmed a serum level of 10 mg/dl as the best cut-off value [AUC 0.675 (95% CI 0.548–0.786)]. Although sensitivity and specificity were suboptimal (69.0 and 70.4%, respectively)—likely due to the small sample size—this result is in line with those previously reported in the literature. Conclusion: Lp(a) is independently associated with severity of CA in the subgroup of MetS patients.
Collapse
Affiliation(s)
- Anna Laura Cremonini
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Visconti
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Matteo Casula
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edoardo Elia
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Aldo Bonaventura
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,Internal Medicine Department Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Luca Liberale
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Bertolotto
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Nathan Artom
- Department of Internal Medicine, Ospedale S. Paolo di Savona, Savona, Italy
| | - Silvia Minetti
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paola Contini
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniela Verzola
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Aldo Pende
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
20
|
Kayali S, Pasta A, Pellicano R, Fagoonee S, Giuliana E, Facchini C, Pili S, Buccilli S, Labanca S, Borro P. Effect of contrast-enhanced ultrasound (CEUS) on liver stiffness measurements obtained by transient and shear-wave elastography. Panminerva Med 2022; 64:479-484. [PMID: 35388660 DOI: 10.23736/s0031-0808.22.04719-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since liver fibrosis is one of the most accurate predictors of prognosis in hepatopatic patients, its accurate assessment and staging is a major public health issue. Transient elastography (TE, Fibroscan®) and shear wave elastography (SWE) represent the gold standard techniques among non-invasive methods to assess liver fibrosis. Contrast-enhanced ultrasound (CEUS) is increasingly used to diagnose the nature of liver lesions and is often performed together with TE and SWE. In this study we evaluated the effect of CEUS on liver stiffness measurements obtained by TE and SWE. METHODS A retrospective analysis of ultrasound (US) exams performed by an expert operator was carried out. TE and SWE were performed 30 seconds before and after the execution of CEUS. Statistical analysis was carried out using the statistical software R. Kolmogorov-Smirnov analysis was performed to test the normality of continuous variables. The pre- and post-CEUS liver stiffness values were compared using the Wilcoxon's test. RESULTS Ninety-six patients were enrolled. While the measurements were comparable when performed with TE, those obtained by SWE decreased by 6% after administration of the contrast agent (P= 0.0005). Fibrosis stage deviated between pre- and post-CEUS in 16 (17%) patients with Fibroscan® and 22 (23%) patients with SWE. Among the latter, in 9 cases (10%) a deviation from absent-low (F0-F2) to high-fibrosis (F3, F4), or vice versa, occurred. CONCLUSIONS Our study, the first to assess the effects of CEUS on US elastography, shows that the contrast agent (Sonovue®) does not significantly affect liver stiffness measurements obtained by TE, whereas the accuracy decreases when performed by SWE.
Collapse
Affiliation(s)
- Stefano Kayali
- Gastroenterology clinic, IRCCS Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology clinic, IRCCS Policlinico San Martino, Genoa, Italy
| | | | - Sharmila Fagoonee
- National Research Council, Molecular Biotechnology Center (CNR), Turin, Italy
| | | | - Chiara Facchini
- Gastroenterology clinic, IRCCS Policlinico San Martino, Genoa, Italy
| | - Simona Pili
- SC Pharmacy ASL3, Villa Scassi Hospital, Genoa, Italy
| | - Silvia Buccilli
- Gastroenterology clinic, IRCCS Policlinico San Martino, Genoa, Italy
| | - Sara Labanca
- Gastroenterology clinic, IRCCS Policlinico San Martino, Genoa, Italy
| | - Paolo Borro
- Hepatobiliopancreatic and Liver transplant Surgery Unit, IRCCS Policlinico San Martino, Genoa, Italy -
| |
Collapse
|
21
|
Sukkar SG, Traverso N, Furfaro AL, Tasso B, Marengo B, Domenicotti C, Pisciotta L, Pasta A, Marinari UM, Pronzato MA, Cottalasso D. Whey proteins inhibit food intake and tend to improve oxidative balance in obese zucker rats. Eat Weight Disord 2021; 26:2453-2461. [PMID: 33426629 DOI: 10.1007/s40519-020-01100-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 12/19/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/AIMS Whey proteins (WP), obtained from milk after casein precipitation, represent a heterogeneous group of proteins. WP are reported to inhibit food intake in diet-induced experimental obesity; WP have been proposed as adjuvant therapy in oxidative stress-correlated pathologies. This work evaluates the effects of WP in comparison with casein, as a source of alimentary proteins, on food intake, weight growth and some indexes of oxidative equilibrium in Zucker Rats, genetically prone to obesity. METHODS We monitored food intake and weight of Zucker Rats during the experiment, and some markers of oxidative equilibrium. RESULTS WP induced significant decrease of food intake in comparison to casein (WP 80.41 ± 1.069 ml/day; CAS: 88.95 ± 1.084 ml/day; p < 0.0005). Body weight growth was slightly reduced, and the difference was just significant (WP 128.2 ± 6.56 g/day; CAS 145.2 ± 3.29 g/day; p = 0.049), while plasma HNE level was significantly lower in WP than in CAS (WP 41.2 ± 6.3 vs CAS 69.61 ± 4.69 pmol/ml, p = 0.007). Mild amelioration of oxidative equilibrium was indicated by a slight increase of total glutathione both in the liver and in the blood and a significant decrease of plasma 4-hydroxynonenal in the group receiving WP. CONCLUSIONS The effect of WP on food intake and weight growth in Zucker Rats is particularly noteworthy since the nature of their predisposition to obesity is genetic; the possible parallel amelioration of the oxidative balance may constitute a further advantage of WP since oxidative stress is believed to be interwoven to obesity, metabolic syndrome and their complications.
Collapse
Affiliation(s)
- S G Sukkar
- Dietetics and Nutritional Unit, IRCCS Ospedale Policlinico San Martino Di Genova, Largo R. Benzi 2, 16132, Genoa, Italy.
| | - N Traverso
- DIMES, General Pathology Section, University of Genoa, Genoa, Italy
| | - A L Furfaro
- DIMES, General Pathology Section, University of Genoa, Genoa, Italy
| | - B Tasso
- DISCIFAR, University of Genoa, Genoa, Italy
| | - B Marengo
- DIMES, General Pathology Section, University of Genoa, Genoa, Italy
| | - C Domenicotti
- DIMES, General Pathology Section, University of Genoa, Genoa, Italy
| | - L Pisciotta
- Dietetics and Nutritional Unit, IRCCS Ospedale Policlinico San Martino Di Genova, Largo R. Benzi 2, 16132, Genoa, Italy
- Department of Internal Medicine and Medical Specialties, University of Genoa, DIMI, Genoa, Italy
| | - A Pasta
- Department of Internal Medicine and Medical Specialties, University of Genoa, DIMI, Genoa, Italy
| | - U M Marinari
- DIMES, General Pathology Section, University of Genoa, Genoa, Italy
| | - M A Pronzato
- DIMES, General Pathology Section, University of Genoa, Genoa, Italy
| | - D Cottalasso
- DIMES, General Pathology Section, University of Genoa, Genoa, Italy
| |
Collapse
|
22
|
Pasta A, Borro P, Cremonini AL, Formisano E, Tozzi G, Cecchi S, Fresa R, Labanca S, Djahandideh A, Sukkar SG, Picciotto A, Pisciotta L. Effect of a common missense variant in LIPA gene on fatty liver disease and lipid phenotype: New perspectives from a single-center observational study. Pharmacol Res Perspect 2021; 9:e00820. [PMID: 34476902 PMCID: PMC8413903 DOI: 10.1002/prp2.820] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022] Open
Abstract
Lysosomal acid lipase deficiency (LAL-D) is an autosomal recessive disease characterized by hypoalphalipoproteinemia, mixed hyperlipemia, and fatty liver (FL) due to mutations in LIPAse A, lysosomal acid type (LIPA) gene. The rs1051338 single-nucleotide polymorphism (SNP) in LIPA gene, in vitro, could adversely affect the LAL activity (LAL-A). Nonalcoholic fatty liver disease (NAFLD) is often associated with metabolic syndrome, and the diagnosis requires the exclusion of excess of alcohol intake and other causes of hepatic disease. The aim of the study was to evaluate the impact of rs1051338 rare allele on lipid phenotype, severity of FL, and LAL-A in patients suffering from dyslipidemia associated with NAFLD. We selected 74 subjects with hypoalphalipoproteinemia or mixed hyperlipemia and evaluated transaminases, liver assessment with controlled attenuation parameter (CAP), LAL-A, rs1051338 SNP genotype. The presence of rare allele caused higher levels of triglycerides and hepatic transaminase and lower levels of high-density lipoprotein cholesterol (HDL-C). Multivariate analysis highlighted independent association between rare allele and FL severity in subjects with NAFLD. The rs1051338 SNP may modulate FL severity and atherogenic dyslipidemia in patients suffering from NAFLD.
Collapse
Affiliation(s)
- Andrea Pasta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Borro
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Anna Laura Cremonini
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elena Formisano
- Nutritional Unit ASL-1 Imperiese, Giovanni Borea Civil Hospital, Sanremo, Italy
| | - Giulia Tozzi
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Department of Pediatrics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Cecchi
- Hepatology, Gastroenterology and Nutrition Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Raffaele Fresa
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Sara Labanca
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Afscin Djahandideh
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Samir Giuseppe Sukkar
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonino Picciotto
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
23
|
Borro P, Ziola S, Pasta A, Trombini M, Labanca S, Marenco S, Solarna D, Pisciotta L, Baldissarro I, Picciotto A, Dellepiane S. Hepatic Elastometry and Glissonian Line in the Assessment of Liver Fibrosis. Ultrasound Med Biol 2021; 47:947-959. [PMID: 33451815 DOI: 10.1016/j.ultrasmedbio.2020.12.015] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
The aim of this study was to identify a method for staging hepatic fibrosis using a non-invasive, rapid and inexpensive technique based on ultrasound morphologic hepatic features. A total of 215 patients with different liver diseases underwent B-mode (2-D brightness mode) ultrasonography, vibration-controlled transient elastography, 2-D shear wave elastography and measurement of the controlled attenuation parameter with transient elastography. B-Mode images of the anterior margin of the left lobe were obtained and processed with automatic Genoa Line Quantification (GLQ) software based on a neural network for staging liver fibrosis. The accuracy of GLQ was 90.6% during model training and 78.9% in 38 different patients with concordant elastometric measures. Receiver operating characteristic curve analysis of GLQ performance using vibration-controlled transient elastography as a reference yielded areas under the curves of 0.851 for F ≥ F1, 0.793 for F ≥ F2, 0.784 for F ≥ F3 and 0.789 for F ≥ F4. GLQ has the potential to be a rapid, easy-to-perform and tolerable method in the staging of liver fibrosis.
Collapse
Affiliation(s)
- Paolo Borro
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
| | - Sebastiano Ziola
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Andrea Pasta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Marco Trombini
- Department of Electrical, Electronics and Telecommunication Engineering and Naval Architecture (DITEN), University of Genoa, Genoa, Italy
| | - Sara Labanca
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Simona Marenco
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - David Solarna
- Department of Electrical, Electronics and Telecommunication Engineering and Naval Architecture (DITEN), University of Genoa, Genoa, Italy
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, Genoa, Italy; Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Antonino Picciotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Silvana Dellepiane
- Department of Electrical, Electronics and Telecommunication Engineering and Naval Architecture (DITEN), University of Genoa, Genoa, Italy
| |
Collapse
|
24
|
Formisano E, Di Maio P, Ivaldi C, Sferrazzo E, Arieta L, Bongiovanni S, Panizzi L, Valentino E, Pasta A, Giudice M, Demontis S. Nutritional therapy for patients with coronavirus disease 2019 (COVID-19): Practical protocol from a single center highly affected by an outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Nutrition 2021; 82:111048. [PMID: 33277149 PMCID: PMC7645291 DOI: 10.1016/j.nut.2020.111048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/01/2020] [Revised: 08/26/2020] [Accepted: 11/02/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) carries a high risk for malnutrition owing to the state of debilitation that results from acute respiratory failure symptoms. The aim of this study was to provide an approach to reduce the risk for malnutrition and improve patients' clinical outcomes. METHODS Short age-adjusted Nutritional Risk Screening was performed with 94 non-intensive care unit (ICU) patients admitted to the Giovanni Borea Civil Hospital in Sanremo. Forty-nine patients in the ICU were considered at risk for malnutrition without screening and were fed with enteral nutrition plus supplemental parenteral nutrition. In the non-ICU setting, patients underwent a personalized nutritional protocol, considering their conditions, which consisted of a high-protein and high-calorie pureed diet, oral nutritional supplements, and/or artificial nutrition or other personalized nutritional path. RESULTS The nutritional treatment was well tolerated by the patients. Of the non-ICU patients, 19.1% died. They were mainly women, with higher body mass indices and older in age. Of the patients in the ICU, 53.1% died. Of the 94 non-ICU patients, 72 scored positive on at least one nutritional risk screening item (excluding age). Of the 94 non-ICU patients, 68 were >70 y of age. Non-ICU patients whose energy and protein needs were not met were older (P = 0.01) and had a higher death rate than patients whose needs were met (P < 0.001). CONCLUSIONS This protocol should not be considered as a guideline; rather, it is intended to report the clinical experience of a nutrition team in an Italian reference center for the treatment of patients with COVID-19. Nutritional strategies should be implemented to prevent worsening of clinical outcomes.
Collapse
Affiliation(s)
- Elena Formisano
- Nutritional Unit, Giovanni Borea Civil Hospital, Sanremo, Italy
| | - Pasquale Di Maio
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, Sanremo, Italy
| | - Cecilia Ivaldi
- Nutritional Unit, Giovanni Borea Civil Hospital, Sanremo, Italy
| | - Elsa Sferrazzo
- Nutritional Unit, Giovanni Borea Civil Hospital, Sanremo, Italy
| | | | | | | | - Elena Valentino
- Nutritional Unit, Giovanni Borea Civil Hospital, Sanremo, Italy
| | - Andrea Pasta
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Marco Giudice
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, Sanremo, Italy
| | | |
Collapse
|
25
|
Formisano E, Pasta A, Cremonini A, Di Lorenzo I, Pisciotta L. Evaluation of adherence to Mediterranean diet, assessed by a food frequency questionnaire, in dyslipidemic patients and evaluation of dietary intervention efficacy. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
26
|
Pasta A, Cremonini A, Formisano E, Fresa R, Bertolini S, Pisciotta L. Long-term follow-up of genetically confirmed patients with familial hypercholesterolemia from the treatment with the first-generation statins to monoclonal anti-PCSK9 antibodies. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Cremonini A, Pasta A, Visconti L, Formisano E, Artom N, Carbone F, Montecucco F, Pende A, Pisciotta L. The levels of lipoprotein (a) in the modulation of carotid atherosclerosis risk in a group of patients with metabolic syndrome in primary prevention. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
28
|
Formisano E, Pasta A, Cremonini A, Garrubba C, Borro P, Picciotto A, Pisciotta L. Role of dietary intervention in patients with metabolic syndrome and NAFLD-NASH. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
29
|
Gomaraschi M, Arnaboldi L, Ossoli A, Giorgio E, Pisciotta L, Lucchi T, Grigore L, Pavanello C, Granata A, Pasta A, Arosio B, Azzolino D, Baragetti A, Corsini A, Catapano A, Calabresi L. LIPA gene mutations affect the composition of lipoproteins: Enrichment in ACAT-derived cholesteryl esters. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
30
|
Bertolini S, Calandra S, Arca M, Averna M, Catapano AL, Tarugi P, Bartuli A, Bucci M, Buonuomo PS, Calabrò P, Casula M, Cefalù AB, Cicero A, D'Addato S, D'Erasmo L, Fasano T, Iannuzzo G, Ibba A, Negri EA, Pasta A, Pavanello C, Pisciotta L, Rabacchi C, Ripoli C, Sampietro T, Sbrana F, Sileo F, Suppressa P, Trenti C, Zenti MG. Homozygous familial hypercholesterolemia in Italy: Clinical and molecular features. Atherosclerosis 2020; 312:72-78. [DOI: 10.1016/j.atherosclerosis.2020.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 12/17/2022]
|
31
|
Stefanutti C, Pisciotta L, Favari E, Di Giacomo S, Vacondio F, Zenti MG, Morozzi C, Berretti D, Mesce D, Vitale M, Pasta A, Ronca A, Garuti A, Manfredini M, Anglés-Cano E, Marcovina SM, Watts GF. Lipoprotein(a) concentration, genetic variants, apo(a) isoform size, and cellular cholesterol efflux in patients with elevated Lp(a) and coronary heart disease submitted or not to lipoprotein apheresis: An Italian case-control multicenter study on Lp(a). J Clin Lipidol 2020; 14:487-497.e1. [PMID: 32718857 DOI: 10.1016/j.jacl.2020.05.002] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) risk is greater with higher plasma lipoprotein(a)[Lp(a)] concentrations or smaller apoisoform size and putatively with increased cellular cholesterol loading capacity (CLC). The relationship between Lp(a) and CLC is not known. Information on Lp(a) polymorphisms in Italian patients is lacking. OBJECTIVE The objective of this study was to determine relationships between Lp(a) and CLC, the impact of lipoprotein apheresis (LA), and describe the genetic profile of Lp(a). METHODS We conducted a multicenter, observational study in Italian patients with hyperLp(a) and premature CAD with (n = 18)/without (n = 16) LA in which blood samples were analyzed for Lp(a) parameter and CLC. Genetic profiling of LPA was conducted in patient receiving LA. RESULTS Mean macrophage CLC of the pre-LA serum was significantly higher than that of normolipidemic controls (19.7 ± 0.9 μg/mg vs 16.01 ± 0.98 μg/mg of protein, respectively). After LA, serum macrophage CLC was markedly lower relative to preapheresis (16.1 ± 0.8 μg/mg protein; P = .003) and comparable with CLC of the normolipidemic serum. LA did not significantly affect average apo(a) isoform size distribution. No anthropometric or lipid parameters studied were related to serum CLC, but there was a relationship between CLC and the Lp(a) plasma concentration (P = .035). DNA analysis revealed a range of common genetic variants. Two rare, new variants were identified: LPA exon 21, c.3269C>G, p.Pro1090Arg, and rs41259144 p.Arg990Gln, c.2969G>A CONCLUSIONS: LA reduces serum Lp(a) and also reduces macrophage CLC. Novel genetic variants of the LPA gene were identified, and geographic variations were noted. The complexity of these polymorphisms means that genetic assessment is not a predictor of CAD risk in hyperLp(a).
Collapse
Affiliation(s)
- Claudia Stefanutti
- Department of Molecular Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, 'Umberto I' Hospital - 'Sapienza' University of Rome, Rome, Italy.
| | - Livia Pisciotta
- Department of Internal Medicine - Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Elda Favari
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Serafina Di Giacomo
- Department of Molecular Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, 'Umberto I' Hospital - 'Sapienza' University of Rome, Rome, Italy
| | | | - Maria Grazia Zenti
- Endocrinology and Metabolic Diseases, Civile Maggiore Hospital of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Claudia Morozzi
- Department of Molecular Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, 'Umberto I' Hospital - 'Sapienza' University of Rome, Rome, Italy
| | | | - Dario Mesce
- Department of Molecular Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, 'Umberto I' Hospital - 'Sapienza' University of Rome, Rome, Italy
| | - Marco Vitale
- Department of Molecular Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, 'Umberto I' Hospital - 'Sapienza' University of Rome, Rome, Italy
| | - Andrea Pasta
- Department of Internal Medicine, University of Genoa, Italy
| | - Annalisa Ronca
- Department of Food and Drug, University of Parma, Parma, Italy; Endocrinology and Metabolic Diseases, Civile Maggiore Hospital of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Anna Garuti
- Department of Internal Medicine, University of Genoa, Italy
| | | | - Eduardo Anglés-Cano
- Inserm UMR_S1140 "Innovative Therapies in Haemostasis" Faculté de Pharmacie de Paris, Université Paris Descartes, Paris, France; French Institute of Health and Medical Research (Inserm), France
| | - Santica Marija Marcovina
- Department of Medicine, Northwest Lipid Research Laboratories, University of Washington, Seattle, WA, USA
| | - Gerald Francis Watts
- School of Medicine, Faculty of Health and Medical Sciences - Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital University of Western Australia, Perth, Western Australia, Australia
| | | |
Collapse
|
32
|
Pasta A, Cremonini AL, Pisciotta L, Buscaglia A, Porto I, Barra F, Ferrero S, Brunelli C, Rosa GM. PCSK9 inhibitors for treating hypercholesterolemia. Expert Opin Pharmacother 2020; 21:353-363. [DOI: 10.1080/14656566.2019.1702970] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Andrea Pasta
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | | | - Livia Pisciotta
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Angelo Buscaglia
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Italo Porto
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, University of Genoa, Genova, Italy
| | - Gian Marco Rosa
- Clinic of Cardiovascular Diseases, University of Genoa, Genova, Italy
| |
Collapse
|
33
|
Formisano E, Pasta A, Cremonini AL, Favari E, Ronca A, Carbone F, Semino T, Di Pierro F, Sukkar SG, Pisciotta L. Efficacy of Nutraceutical Combination of Monacolin K, Berberine, and Silymarin on Lipid Profile and PCSK9 Plasma Level in a Cohort of Hypercholesterolemic Patients. J Med Food 2019; 23:658-666. [PMID: 31663806 DOI: 10.1089/jmf.2019.0168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The guidelines for the treatment of dyslipidemias include the use of nutraceuticals (NUTs) in association with lifestyle modifications to achieve therapeutic goals. In NUT pill, different substances may be associated; in this study we investigated a combined NUT containing monacolin K (MonK)+KA (1:1), berberine (BBR), and silymarin. The aim of the study was to evaluate low-density lipoprotein cholesterol (LDL-C) reduction in 53 patients suffering from polygenic hypercholesterolemia, characterized by a low/intermediate cardiovascular risk calculated with SCORE algorithm. The effects on lipid profile of 2-month treatment with NUT containing MonK+KA (1:1), BBR, and sylimarin, were compared with Atorvastatin (ATO) 10 mg administrated in a matched control group. Serum proprotein convertase subtilisin/kexin type 9 (PCSK9) levels and the cholesterol loading capacity (CLC) were determined at baseline and at the end of the study in NUT-treated group; variations were assessed. NUT was effective as lipid-lowering agent with a wide interindividual response variability (mean LDL-C from 170.8 ± 19.9 to 123.8 ± 20.0 with a change of -47.0 ± 21.5 mg/dL; P < .001) and the effect was similar to that induced by ATO. The use of NUT significantly modified PCSK9 levels (P < .01) and CLC (P < .001), ultimately suppressing the serum-mediated foam cell generation directly measured on human macrophages. NUT reduces LDL-C levels with an effect similar to what is induced by 10 mg of ATO and ex vivo improves the functional profile of lipoproteins with antiatherogenic action.
Collapse
Affiliation(s)
| | - Andrea Pasta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Anna L Cremonini
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Elda Favari
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Annalisa Ronca
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Federico Carbone
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Tommaso Semino
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Livia Pisciotta
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| |
Collapse
|
34
|
Roscigno M, Scattoni V, Bertini R, Pasta A, Montorsi F, Rigatti P. Diagnosis of prostate cancer. State of the art. MINERVA UROL NEFROL 2004; 56:123-45. [PMID: 15195022] [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: 04/29/2023]
Abstract
The widespread acceptance of prostate-specific antigen (PSA) measurement as an early detection method for prostate cancer (Pca), coupled with the recent heightened public awareness of Pca as a common disease, has led to an increase in the detection of Pca. It has been established that digital rectal examination (DRE) and PSA are the most useful front-line methods for assessing an individual's risk of Pca. In addition to an elevated PSA above 4 ng/mL and an abnormal DRE, the decision to proceed with TRUS-guided biopsy may also be supported by other factors. Determining the presence of a significant rise in PSA between tests, whether the degree of PSA is concordant with the size of the prostate, and age appropriate PSA may aid in the interpretation of this risk. Grayscale transrectal ultrasound (TRUS) has been established as the first choice imaging technique making it possible to take biopsies, measure the volume and obtain a general overview of the prostate. To improve, however, the TRUS detection rate of Pca, many ultrasonographic technique improvements have been introduced and continuously evaluated. As for prostate biopsy, in the prostate with visible lesions, lesion-guided biopsies only play a role in combination with systematic biopsies, while the systematic prostate biopsy scheme should at the present time include 10 or 12 cores according to prostatic weight. The other imaging techniques actually play a marginal role in Pca detection, but may be useful for staging newly diagnosed Pca or in patient re-staging in case of biochemical failure after radical treatment.
Collapse
Affiliation(s)
- M Roscigno
- Department of Urology, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
35
|
Santambrogio R, Bianchi P, Pasta A, Palmisano A, Montorsi M. Ultrasound-guided interventional procedures of the liver during laparoscopy: technical considerations. Surg Endosc 2002; 16:349-54. [PMID: 11967695 DOI: 10.1007/s004640090082] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2000] [Accepted: 05/24/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND The increased application of laparoscopy to oncological cases has also expanded the applications of laparoscopic ultrasound (LUS). LUS-guided interventional procedures are often used for the staging of neoplastic disease. However, considerable expertise is required to perform the US-guided maneuvers. METHODS Based on our 7-year experience with laparoscopic ultrasound, we discuss a number of technical and practical aspects related to the performance of interventional procedures during LUS of the liver. RESULTS We performed 146 laparoscopic ultrasound exams in patients with neoplastic diseases. In all, 244 liver lesions were biopsied and 151 needle placements were made to perform radiofrequency ablation or ethanol injection. We discuss our choice of laparoscopic equipment and type of needle required (whether for biopsies or for interventional procedures). We also describe the technical characteristics of ultrasound probes and equipment, the correct approach to the patient, and the method that we employ to identify and then puncture the target lesion. CONCLUSION The proper technique for interventional procedures during laparoscopic ultrasound can be mastered relatively quickly by a surgeon who is already familiar with traditional ultrasound techniques.
Collapse
Affiliation(s)
- R Santambrogio
- Dipartimento di Medicina e Chirurgia San Paolo, Clinica Chirurgica, Università degli Studi di Milano, via A. di Rudinì 8, Milan, Italy.
| | | | | | | | | |
Collapse
|