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Piazzolla M, Marmo R, Terracciano F, Perri F, Biscaglia G. Asymptomatic retention of fragmented small bowel capsule endoscopy retrieved by retrograde double-balloon enteroscopy in Crohn's disease. Eur J Gastroenterol Hepatol 2021; 33:e1082-e1083. [PMID: 33905218 DOI: 10.1097/meg.0000000000002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mariano Piazzolla
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia
| | - Riccardo Marmo
- Gastroenterology Unit, "L. Curto" Hospital, Polla, Salerno
| | - Fulvia Terracciano
- Gastroenterology and Digestive Endoscopy Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Francesco Perri
- Gastroenterology and Digestive Endoscopy Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Giuseppe Biscaglia
- Gastroenterology and Digestive Endoscopy Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
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Cocomazzi F, Gentile M, Perri F, Bossa F, Merla A, Ippolito A, Cubisino R, Carparelli S, Marra A, Mileti A, Piazzolla M, Paolillo R, Copetti M, Parente P, Graziano P, Di Leo A, Andriulli A. Correction to: Accuracy and inter-observer agreement of the nice and kudo classifications of superficial colonic lesions: a comparative study. Int J Colorectal Dis 2021; 36:1569. [PMID: 33712905 DOI: 10.1007/s00384-021-03905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Francesco Cocomazzi
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy.,Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Marco Gentile
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy.
| | - Francesco Perri
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Fabrizio Bossa
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Merla
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Ippolito
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Rossella Cubisino
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Sonia Carparelli
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Antonella Marra
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Alessia Mileti
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy.,Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mariano Piazzolla
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy.,Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Rosa Paolillo
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy.,Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Paolo Graziano
- Pathology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Angelo Andriulli
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
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Cocomazzi F, Gentile M, Perri F, Bossa F, Merla A, Ippolito A, Cubisino R, Carparelli S, Marra A, Mileti A, Piazzolla M, Paolillo R, Copetti M, Parente P, Graziano P, Di Leo A, Andriulli A. Accuracy and inter-observer agreement of the nice and kudo classifications of superficial colonic lesions: a comparative study. Int J Colorectal Dis 2021; 36:1561-1568. [PMID: 33649902 DOI: 10.1007/s00384-021-03897-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE For superficial colonic lesions, the NICE and Kudo classifications are used in the in vivo prediction of histology and as guide to therapy. The NICE system derives information from unmagnified NBI endoscopic images. The Kudo one necessitates a magnification, but, as this tool is not commonly available, it is applied also to characterize unmagnified pictures to compare their diagnostic performances. METHODS We conducted a prospective comparison of the NICE versus the Kudo classification for the differential diagnosis of colonic polyps taking histology as the gold standard. The inter-observer agreement for both classifications among 11 colonoscopists was also evaluated. Short unmagnified NBI videoclips of 64 colonic polyps were sent twice to the participants. In the first round, they classified the lesions according to the NICE classification; 4 months later, the same videos were assessed with the Kudo system. The diagnosis provided by the participants was grouped in non-neoplastic, non-invasive neoplasia, invasive neoplasia. RESULTS Overall, the diagnostic accuracy was 82% (95%CI: 79-85) with the NICE system and 81% (95%CI: 78-84) with the Kudo one (ρ = 0.78). The accuracy of the NICE classification for non-neoplastic lesions was greater compared with the Kudo's (ρ = 0.03). Sensitivity sub-analyses revealed a higher ability of the NICE in distinguishing between neoplastic vs. non-neoplastic lesions (ρ = 0.01). The overall inter-rater agreement did not differ when the classifications were compared. CONCLUSION The NICE and the Kudo classifications might be considered comparable. Our data could allow the use of the NBI Kudo classification even in those centers where magnification is not available.
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Affiliation(s)
- Francesco Cocomazzi
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Marco Gentile
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy.
| | - Francesco Perri
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Fabrizio Bossa
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Merla
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Ippolito
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Rossella Cubisino
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Sonia Carparelli
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Antonella Marra
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Alessia Mileti
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mariano Piazzolla
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Rosa Paolillo
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Paolo Graziano
- Pathology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Angelo Andriulli
- Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
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Cocomazzi F, Gentile M, Perri F, Merla A, Bossa F, Piazzolla M, Ippolito A, Terracciano F, Giuliani AP, Cubisino R, Marra A, Carparelli S, Mileti A, Paolillo R, Fontana A, Copetti M, Di Leo A, Andriulli A. Interobserver agreement of the Paris and simplified classifications of superficial colonic lesions: a Western study. Endosc Int Open 2021; 9:E388-E394. [PMID: 33655038 PMCID: PMC7895665 DOI: 10.1055/a-1352-3437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The Paris classification of superficial colonic lesions has been widely adopted, but a simplified description that subgroups the shape into pedunculated, sessile/flat and depressed lesions has been proposed recently. The aim of this study was to evaluate the accuracy and inter-rater agreement among 13 Western endoscopists for the two classification systems. Methods Seventy video clips of superficial colonic lesions were classified according to the two classifications, and their size estimated. The interobserver agreement for each classification was assessed using both Cohen k and AC1 statistics. Accuracy was taken as the concordance between the standard morphology definition and that made by participants. Sensitivity analyses investigated agreement between trainees (T) and staff members (SM), simple or mixed lesions, distinct lesion phenotypes, and for laterally spreading tumors (LSTs). Results Overall, the interobserver agreement for the Paris classification was substantial (κ = 0.61; AC1 = 0.66), with 79.3 % accuracy. Between SM and T, the values were superimposable. For size estimation, the agreement was 0.48 by the κ-value, and 0.50 by AC1. For single or mixed lesions, κ-values were 0.60 and 0.43, respectively; corresponding AC1 values were 0.68 and 0.57. Evaluating the several different polyp subtypes separately, agreement differed significantly when analyzed by the k-statistics (0.08-0.12) or the AC1 statistics (0.59-0.71). Analyses of LSTs provided a κ-value of 0.50 and an AC1 score of 0.62, with 77.6 % accuracy. The simplified classification outperformed the Paris classification: κ = 0.68, AC1 = 0.82, accuracy = 91.6 %. Conclusions Agreement is often measured with Cohen's κ, but we documented higher levels of agreement when analyzed with the AC1 statistic. The level of agreement was substantial for the Paris classification, and almost perfect for the simplified system.
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Affiliation(s)
- Francesco Cocomazzi
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy,University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Marco Gentile
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Perri
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Merla
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Fabrizio Bossa
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Mariano Piazzolla
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy,University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Antonio Ippolito
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Fulvia Terracciano
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Arcangela Patrizia Giuliani
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Rossella Cubisino
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Antonella Marra
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Sonia Carparelli
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Alessia Mileti
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy,University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Rosa Paolillo
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy,University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione “Casa Sollievo della Sofferenza”, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione “Casa Sollievo della Sofferenza”, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Alfredo Di Leo
- University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Angelo Andriulli
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
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Losurdo G, Giorgio F, Pricci M, Girardi B, Russo F, Riezzo G, Martulli M, Piazzolla M, Cocomazzi F, Abbruzzi F, Parente E, Paolillo R, Mileti A, Iannone A, Principi M, Ierardi E, Di Leo A. Helicobacter pylori Primary and Secondary Genotypic Resistance to Clarithromycin and Levofloxacin Detection in Stools: A 4-Year Scenario in Southern Italy. Antibiotics (Basel) 2020; 9:antibiotics9100723. [PMID: 33096925 PMCID: PMC7589162 DOI: 10.3390/antibiotics9100723] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Antibiotic resistance has become an emerging problem for treating Helicobacter pylori (H. pylori) infection. Clarithromycin and levofloxacin are two key antibiotics used for its eradication. Therefore, we reviewed our experience with genotypic resistance analysis in stools to both clarithromycin and levofloxacin in the last four years to evaluate time trends, both in naive and failure patients. Patients collected a fecal sample using the THD fecal test device. Real-time polymerase chain reaction was performed to detect point mutations conferring resistance to clarithromycin (A2142C, A2142G, and A2143G in 23S rRNA) and levofloxacin (substitutions at amino acid position 87 and 91 of gyrA). One hundred and thirty-five naive patients were recruited between 2017-2020. Clarithromycin resistance was detected in 37 (27.4%). The time trend did not show any significant variation from 2017 to 2020 (p = 0.33). Primary levofloxacin resistance was found in 26 subjects (19.2%), and we observed a dramatic increase in rates from 2017 (10%) to 2018 (3.3%), 2019 (20%), and 2020 (37.8%). Ninety-one patients with at least one eradication failure were recruited. Secondary resistance to clarithromycin and levofloxacin was found in 59 (64.8%) and 45 patients (59.3%), respectively. In conclusion, our geographic area has a high risk of resistance to clarithromycin. There is also a progressive spreading of levofloxacin-resistant strains.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
- Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | | | - Maria Pricci
- THD SpA, 42015 Correggio, Italy; (F.G.); (M.P.); (B.G.)
| | - Bruna Girardi
- THD SpA, 42015 Correggio, Italy; (F.G.); (M.P.); (B.G.)
| | - Francesco Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Giuseppe Riezzo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Manuela Martulli
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (F.R.); (G.R.); (M.M.)
| | - Mariano Piazzolla
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Francesco Cocomazzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Francesco Abbruzzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Elisabetta Parente
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Rosa Paolillo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Alessia Mileti
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; (G.L.); (M.P.); (F.C.); (F.A.); (E.P.); (R.P.); (A.M.); (A.I.); (M.P.); (E.I.)
- Correspondence: ; Tel.: +39-80-559-2925
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Girardi B, Pricci M, Giorgio F, Piazzolla M, Iannone A, Losurdo G, Principi M, Barone M, Ierardi E, Di Leo A. Silymarin, boswellic acid and curcumin enriched dietetic formulation reduces the growth of inherited intestinal polyps in an animal model. World J Gastroenterol 2020; 26:1601-1612. [PMID: 32327909 PMCID: PMC7167411 DOI: 10.3748/wjg.v26.i14.1601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/10/2019] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Some substances of plant origin have been reported to exert an effect in reducing intestinal neoplasm development, especially in animal models. Adenomatous polyposis coli multiple intestinal neoplasia - ApcMin/+ is the most studied murine model of genetic intestinal carcinogenesis.
AIM To assess whether an enriched nutritional formulation (silymarin, boswellic acid and curcumin) with proven “in vitro” and “in vivo” anti-carcinogenetic properties may prevent inherited intestinal cancer in animal model.
METHODS Forty adenomatous polyposis coli multiple intestinal neoplasia - ApcMin/+ mice were used for the study of cancer prevention. They were divided into two groups: 20 assumed standard and 20 enriched diet. At the 110th d animals were sacrificed. In each group, four subgroups received intraperitoneal bromodeoxyuridine injection at different times (24, 48, 72 and 96 h before the sacrifice) in order to assess epithelial turnover. Moreover, we evaluated the following parameters: Intestinal polypoid lesion number and size on autoptic tissue, dysplasia and neoplasia areas by histological examination of the whole small intestine, inflammation by histology and cytokine mRNA expression by real-time polymerase chain reaction, bromodeoxyuridine and TUNEL immuno-fluorescence for epithelial turnover and apoptosis, respectively. Additionally, we performed western blotting analysis for the expression of estrogen alpha and beta receptors, cyclin D1 and cleaved caspase 3 in normal and polypoid tissues.
RESULTS Compared to standard, enriched diet reduced the total number (203 vs 416) and the mean ± SD/animal (12.6 ± 5.0 vs 26.0 ± 8.8; P < 0.001) of polypoid lesions. In enriched diet group a reduction in polyp size was observed (P < 0.001). Histological inflammation and pro-inflammatory cytokine expression were similar in both groups. Areas of low-grade dysplasia (P < 0.001) and intestinal carcinoma (IC; P < 0.001) were significantly decreased in enriched diet group. IC was observed in 100% in standard and 85% in enriched formulation assuming animals. Enriched diet showed a faster epithelial migration and an increased apoptosis in normal mucosa and low-grade dysplasia areas (P < 0.001). At western blotting, estrogen receptor beta protein was well expressed in normal mucosa of enriched and standard groups, with a more marked trend associated to the first one. Estrogen receptor alpha was similarly expressed in normal and polypoid mucosa of standard and enriched diet group. Cleaved caspase 3 showed in normal mucosa a stronger signal in enriched than in standard diet. Cyclin D1 was more expressed in standard than enriched diet group of both normal and polypoid tissue.
CONCLUSION Our results are suggestive of a chemo-preventive synergic effect of the components (silymarin, boswellic acid and curcumin) of an enriched formulation in inherited IC. This effect may be mediated by the reduction of epithelial proliferation, the increase of apoptosis and the acceleration of villous cell renewal due to dietary formulation intake.
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Affiliation(s)
| | | | | | - Mariano Piazzolla
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Andrea Iannone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Giuseppe Losurdo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Mariabeatrice Principi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Piazzolla M, Castellaneta N, Novelli A, Agolini E, Cocciadiferro D, Resta L, Duda L, Barone M, Ierardi E, Di Leo A. Nonsense variant of ATP8B1 gene in heterozygosis and benign recurrent intrahepatic cholestasis: A case report and review of literature. World J Hepatol 2020; 12:64-71. [PMID: 32184942 PMCID: PMC7061267 DOI: 10.4254/wjh.v12.i2.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Benign recurrent intrahepatic cholestasis is a genetic disorder with recurrent cholestatic jaundice due to ATP8B1 and ABCB11 gene mutations encoding for hepato-canalicular transporters. Herein, we firstly provide the evidence that a nonsense variant of ATP8B1 gene (c.1558A>T) in heterozygous form is involved in BRIC pathogenesis.
CASE SUMMARY A 29-year-old male showed severe jaundice and laboratory tests consistent with intrahepatic cholestasis despite normal gamma-glutamyltranspeptidase. Acute and chronic liver diseases with viral, metabolic and autoimmune etiology were excluded. Normal intra/extra-hepatic bile ducts were demonstrated by magnetic resonance. Liver biopsy showed: Cholestasis in the centrilobular and intermediate zones with bile plugs and intra-hepatocyte pigment, Kupffer’s cell activation/hyperplasia and preserved biliary ducts. Being satisfied benign recurrent intrahepatic cholestasis diagnostic criteria, ATP8B1 and ABCB11 gene analysis was performed. Surprisingly, we found a novel nonsense variant of ATP8B1 gene (c.1558A>T) in heterozygosis. The variant was confirmed by Sanger sequencing following a standard protocol and tested for familial segregation, showing a maternal inheritance. Immunohistochemistry confirmed a significant reduction of mutated gene related protein (familial intrahepatic cholestasis 1). The patient was treated with ursodeoxycholic acid 15 mg/kg per day and colestyramine 8 g daily with total bilirubin decrease and normalization at the 6th and 12th mo.
CONCLUSION A genetic abnormality, different from those already known, could be involved in familial intrahepatic cholestatic disorders and/or pro-cholestatic genetic predisposition, thus encouraging further mutation detection in this field.
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Affiliation(s)
- Mariano Piazzolla
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Nicola Castellaneta
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Dario Cocciadiferro
- Laboratory of Medical Genetics, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Leonardo Resta
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Loren Duda
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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