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Palliative Care in Heart Failure cardiology setting is still a demanding topic and lacking of clear indications regarding which patients should be referred to palliative care is an actual issue, as confirmed by a systematic review of international literature. Assessment tools facilitate the identification of patient needs and guide the actions of healthcare professionals to address them. Some existing tools described in literature were used with non–cardiological patients, but they cannot be applied to Heart Failure as they are incomplete and investigate non–specific aspects of the disease. Two recent systematic reviews indicate that the most comprehensive and specific tool for Heart Failure patients is the "NAT: PD–HF." The "NAT: PD–HF" has already been translated and validated from English to Dutch and German, but an Italian validation is still missing in literature. It is a quick and easy–to–use tool consisting of four sections that assess the patient’s well–being and quality of life, the caregiver‘s ability to provide assistance and support, both patient’s and caregiver’s needs and requests and any critical element that, if present, would justify a specialist palliative evaluation. Therefore, with prior authorization from the original authors, we proceeded with the translation and transcultural validation of the tool. The study protocol was approved by the Bioethics Committee of Bologna in April 2023. We are currently at the final phase of the protocol, namely testing the tool on the target population by the professionals involved in the care process. The purpose of transcultural validation is to provide the Italian scientific community with the "NAT: PD–HF" tool: throw its incorporation into the medical records of Heart Failure Patients receiving care in the territorial setting, we aim to increase the use of palliative cares and, consequently, the quality of life of patients and caregivers, as demonstrated in the original study.

Pouchitis is the most common complication of Proctocolectomy with ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). The diagnosis of pouchitis requires the presence of symptoms, together with characteristic endoscopic and histological abnormalities. The exact cause of pouchitis is not known. Whereas ‘acute’ pouchitis can be treated rapidly and successfully in the majority of patients, “refractory” and ‘chronic pouchitis’ remain therapeutic challenges to patients and physicians. Metronidazole and Ciprofloxacin budesonide enemas and oral probiotic therapy with VSL#3 all appear to be effective therapies for acute and/or chronic pouchitis. The medical therapy of pouchitis remains largely empiric, and additional multicenter, randomized, double-blind, placebo-con- trolled, dose-ranging trials are needed. In future trials, treatment indications such as active acute or chronic pouchitis and maintenance of remission for acute or chronic pouchitis should be clearly defined.

Bacteria are present throughout the GI tract but their pattern and concentrations vary greatly. Probiotics are living microorganisms that belong to the normal intestinal flora and are important to the health and well-being of the host. The concept of probiotic therapy is still controversial; there are many data from in vitro and animal studies, however, to date the beneficial effects of probiotics in humans have mostly been demonstrated under poorly defined experimental conditions. Several experimental and clinical observations suggest a role for the intestinal microflora in inflammatory bowel disease (IBD) pathogenesis and there is increasing evidence supporting the potential therapeutic role for probiotics in the treatment of IBD. The use of probiotics to treat GI infections has produced contrasting results; their efficacy in the prevention or treatment of infective diarrhoea was evaluated in a large number of studies; however, the most convincing evidence of their benefit concerns rotavirus infection in children. Future research needs to focus on obtaining more precise information on the composition of the enteric microflora and the mechanisms of action of probiotics.

Background: Rectal treatment with mesalazine enemas is the first-line therapy for distal ulcerative colitis. In order to improve the benefits of rectal therapy, a new 60 mL 5-ASA rectal gel enema preparation has been developed using a device which excludes direct contact of the inert propellant gas with the active drug. The purpose of the present study was to assess by scintigraphy the colonic distribution of this new mesalazine rectal gel enema.

Mesalazine suppositories at 500 mg b.d. are a safe and effective treatment for patients with ulcerative proctitis or distal proctosigmoiditis. Recently a mesalazine 1 g suppository (Pentasa) has been developed.

Background: Mucosal inflammation of the ileal pouch (pouchitis) is the major long-term complication after ileal pouch-anal anastomosis for ulcerative colitis. Broad-spectrum antibiotics are the mainstay of treatment, however, 15% of patients with pouchitis have a chronic, treatment-resistant disease.

PURPOSE: The aim of our study was to compare the efficacy and safety of oral mesalazine with mesalazine suppositories in patients with active ulcerative proctitis. PATIENTS AND METHODS: A four-week, randomized, single-blind trial was performed in 58 patients with active, histologically confirmed ulcerative proctitis (≤15 cm) to evaluate the efficacy and safety of oral 800-mg mesalazine tablets taken three times per day (n=29) compared with 400 mg of mesalazine suppositories administered three times per day (n=29). Patients were evaluated at study entry and after two and four weeks. Efficacy evaluations included a disease activity index, which represents a score with four variables: stools frequency, rectal bleeding, mucosal appearance, and physician's assessment of disease severity. Histologic activity was also assessed at study entry and after two and four weeks in accordance with the criteria by Truelove and Richard. Safety assessment included clinical laboratory parameters and adverse event reports. RESULTS: There were no significant differences with regard to baseline comparisons of demographics and severity between the two treatment groups. Improvement in mean disease activity index score was significantly greater with suppositories compared with oral mesalazine, both at two-week and four-week visits (mean disease activity index scores at baseline, two, and four weeks: suppositories = 7.7, 2.59, and 1.48; tablets = 7.42, 5.72, and 3.48, respectively (P<0.001)). The rate of histologic remission was significantly greater with suppositories compared with tablets both at two and four weeks (P<0.01). There were no significant differences in adverse events or clinical laboratory results between treatment groups. CONCLUSIONS: Results of this study indicate that treatment with mesalazine suppositories produces earlier and significantly better results than oral mesalazine in the treatment of active ulcerative proctitis.

Background: Mucosal inflammation of the ileal pouch (pouchitis) is the major long‐term complication after ileal pouch‐anal anastomosis for ulcerative colitis. Broad‐spectrum antibiotics are the mainstay of treatment, however, 15% of patients with pouchitis have a chronic, treatment‐resistant disease.

Background: Rectal treatment with mesalazine enemas is the first‐line therapy for distal ulcerative colitis. In order to improve the benefits of rectal therapy, a new 60 mL 5‐ASA rectal gel enema preparation has been developed using a device which excludes direct contact of the inert propellant gas with the active drug. The purpose of the present study was to assess by scintigraphy the colonic distribution of this new mesalazine rectal gel enema.

Fish oil has been recently proposed as a possible effective treatment in inflammatory bowel disease (IBD); however, a lot of annoying side effects (ie, belching, halitosis, diarrhea, etc) affect patient compliance. We carried out a study of patient tolerance in a group of Crohn's disease (CD) patients with a new fish oil derivative consisting of 500-mg capsules of eicosapentaenoic-docosahexaenoic (EPA 40%-DHA 20%), a free fatty acid mixture (Purepa), and we also evaluated its incorporation into phospholipids, both in plasma and in red cell membranes. Five groups of 10 CD patients in remission received nine Purepa capsules daily in four different preparations (A: uncoated, B: coated, pH 5.5; C: coated, pH 5.5, 60 min time release; D: coated, pH 6.9) and 12 × 1-g capsules daily of a triglyceride preparation (Max-EPA, EPA 18%-DHA 10%), respectively. We coated three of the four Purepa preparations in order to delay the release of contents in an attempt to minimize the side effects. After six weeks of treatment, the group taking Purepa capsules, coated, pH 5.5, 60 min time release (group C) showed the best incorporation of EPA and DHA in red blood cell phospholipid membranes (EPA from 0.2 to 4.4%, DHA from 3.7 to 6.3%), and no side effects were registered, whereas in all other groups side effects were experienced in 50% or more of subjects. This new preparation will make it possible to treat patients for long periods.