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Background Italy has been one of the most affected countries in the world by COVID-19. There has been increasing concern regarding the impact of COVID‐19 on patients with inflammatory bowel disease (IBD), particularly in patients treated with immunosuppressants or biologics. The aim of our study is to understand the incidence of COVID-19 in a large cohort of patients with IBD. Furthermore, we analyzed possible risk factors for infection and severity of COVID-19. Methods This was an observational study evaluating the impact of COVID-19 on IBD patients in a single tertiary center. A 23 multiple-choice-question anonymous survey was administered to 1200 patients with IBD between March 10th and June 10th 2020. Results 1158 questionnaires were analyzed. The majority of patients had Crohn's disease (CD) (60%) and most of them were in clinical remission. Among the 26 patients (2.2%) who tested positive for COVID-19, only 5 (3CD) were on biological treatment and none required hospitalization. Two patients died and were on treatment with mesalazine only. Of the 1158 patients, 521 were on biological therapy, which was discontinued in 85 (16.3%) and delayed in 195 patients (37.4%). A worsening of IBD symptoms was observed in 200 patients on biological therapy (38.4%). Most of these patients, 189 (94.5%), had stopped or delayed biological treatment, while 11 (5.5%) had continued their therapy regularly (p Conclusions Our data are in line with the current literature and confirm a higher incidence compared to the general population. Biological therapy for IBD seems to not be a risk factor for infection and should not be discontinued in order to avoid IBD relapse.

to international guidelines. Moreover the effectiveness of AASLD guidelines application has never been prospectively addressed. This is a prospective survey on a large cohort of newly diagnosed HCC observed in the last 2 years. Material and methods: From September 2008 to September 2010, 710 consecutive patients with HCC referring to 30 non-tertiary referral Hospitals were included. Inclusion criteria were newly detected HCC and cirrhosis. Patients were classified according to Child-Pugh and Meld score and BCLC stage. No prefixed protocols on diagnosis and treatment of HCC were operative. Statistical analysis is based on the first 536 cases. Results: Mean age was 70±4.7 yrs (71% M). Comorbidities were present in 322 patients (76%). Prevalent etiology was HCV (56%). Cirrhosis was Child A in 266 (63%), B in 125 (29%) and mean MELD score was 9.5±5.3. The mean size of nodules was 3.8±2.3 cm, monofocal in 57% and paucifocal in 23% cases. Age > 70 yrs and moderate/severe comorbidities were equally distributed among different BCLC stages. Regular follow-up was recorded in 289 cases (54%). Early HCC was more frequently observed in patients on regular follow-up (71% vs 39%). The most frequently employed imaging technique for diagnosis of HCC was TC (93%) followed by CEUS (62%); MRI was utilized in 17% of cases. Adherence to the non-invasive diagnostic criteria was 59% in nodules = 2 cm and 97% in larger nodules. The overall adherence to BCLC treatment algorithm was 52%. Ratio between ideal and real treatment offered was: OLT 42/9, resection 78/36, ablation 160/152, TACE 129/159, Sorafenib 67/21, palliative 60/134. In 25 cases combination therapy was performed. In particular 119 (40%) patients in BCLC stage A did not receive curative therapies. Conclusions: This translational study showed that adherence to either diagnostic and therapeutic AASLD 2005 algorithms was low particularly in early HCC stages. These discrepancies are mainly due to: 1) the difficulty in applying the algorithms in routine clinical practice and 2) the high prevalence of patients > 70 yrs with relevant comorbidities. The effectiveness of AASLD guidelines application remains to be verified.

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