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Diverticulosis of the colon is an acquired condition that results from herniation of the mucosa and submucosa through defects in the muscular layer. The true prevalence of colonic diverticulosis is difficult to measure because most individuals are asymptomatic. In particularly, in literature, there are few studies about the prevalence of colonic diverticulosis in patients affected by ulcerative colitis (UC).To investigate the prevalence of colonic diverticulosis in UC and in adult patients referred in a single center.Consecutive patients, referred to our institution to undergo a colonoscopy for colorectal cancer screening and/or for UC assessment, between January 1, 2014 and December 31, 2014, were studied.Six hundred five consecutive patients were studied: 438 (72.4%) due to colorectal cancer screening (group A) and 167 (27.6%) for UC assessment (group B). Prevalence of colonic diverticulosis was higher in group A than group B (27.8% vs. 10.8%, P0.0001). Female gender in patients with colonic diverticulosis was higher in group A than group B (55.7% vs. 22.2%, P=0.0106). Sigma and left colon was mainly involved in group A than group B (97.6% vs. 66.7%, P=0.0001), whereas in group B the right colon was mainly involved in group B versus group A (22.2% vs. 0.8%, P=0.0009).Prevalence of colonic diverticulosis was significantly lower in patients with UC than in control group. UC may, therefore, be a protective factor for colonic diverticulosis occurrence.

Background: Hydrogen breath tests are widely used in clinical practice. For a correct evaluation of data, low basal H2 excretion is required, thus, 12-hour fasting is usually prescribed. An additional reduction in the intake of complex carbohydrates in the preceding 24 h is suggested in some centers. The issue, however, has never been directly investigated. Aim: The aim of the present study was to analyze the effect of the pretest diet on the basal H2 excretion and the number of subjects excluded from the test due to high basal H2 excretion. Methods: Two cohorts of 500 consecutive patients undergoing a lactose tolerance test in the years 1997–1998 (when 12-hour fasting was required) and in 2007–2008 (when a low-carbohydrate diet in the preceding 24 h was also prescribed) were retrospectively reviewed. Results: The mean basal H2 excretion was significantly lower (p < 0.0001) in the low-carbohydrate diet group (2.46 ± 6.8 vs. 4.73 ± 3.3 ppm). In 1997–1998, 46/500 patients (9.2%) were excluded from the test due to basal H2 values as compared to 7/500 (1.4%) in the period 2007–2008. Discussion: To the best of our knowledge, ours is the first study to provide objective data on the advantage offered by reducing the intake of complex carbohydrates before H2 breath tests.

To investigate prevalence, type and time of onset of extraintestinal manifestations (EIMs) in a series of Italian inflammatory bowel disease (IBD) patients.Data of 811 IBD consecutive patients, first referred to our Centre from 2000 to 2011, were retrospectively evaluated.Eight hundred and eleven IBD patients (437 M, 374 F) were studied: 595 ulcerative colitis (UC) (73.4%) and 216 Crohn's disease (CD) (26.6%). Among these, 329 (40.6%) showed EIMs: 210 UC (35.3%) and 119 CD (55.1%) (P0.0001). Considering the time of the diagnosis of IBD, 37 EIMs (11.2%) were developed before, 229 (69.6%) after and 63 (19.2%) were simultaneous. The type of EIM were as follows: 240 musculoskeletal (29.6%), in 72 CD patients and in 168 UC (P0.0001); 47 mucocutaneous (5.8%), in 26 CD and in 21 UC (P = 0.0049); 26 ocular (3.2%), in 16 CD and in 10 UC (CD 7.4% vs UC 1.7%, P = 0.0093); 6 hepatobiliary (0.8%); 10 endocrinological (1.2%). In particular, with regards to the involvement of the musculoskeletal system, arthritis Type 1 was found in 41 CD (19%) and in 61 UC (10.2%) (P = 0.0012) and Type 2 in 25 CD (11.6%) and in 100 UC (16.8%) (P = 0.0012).Mucocutaneous manifestations, arthritis Type 1 and uveitis were significantly more frequent in CD than UC. The complications of the musculoskeletal system were the mostly observed ones, often with symptoms more severe than intestinal ones, confirming the need for close cooperation with rheumatologists.

Schwannoma is a tumor originating from the Schwann cells. Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and, in particular, rectal schwannomas are extremely rare. In fact, it is well established that schwannomas appear more frequently in the stomach and in the small intestine, while location in the colon or in the rectum is uncommon. Reading the literature, only few cases of rectal schwannoma have been reported. Their diagnosis is confirmed by the immunohistochemical panel (S-100 protein). When these tumors are located in the colon and in the rectum, radical excision with wide margins is mandatory, due to their tendency to recur locally or become malignant, if left untreated. In the present study, we describe a case of a rectal schwannoma occured in a 72-year-old man, presented as a small polypoid lesion, which was successfully removed in toto by hot-biopsy, during the same endoscopy, due to the dimensons. No recurrence of the lesion was observed after 6 mo of follow-up.

OBJECTIVES: Approximately one third of patients with ulcerative colitis (UC) re - quire surgery. AIM: Aim of this study was to assess the quality of life (QoL) of UC patients who have un - dergone surgery with ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA) compared to UC patients not operated. PATIENTS AND METHODS: Fifty consecutive UC patients for each group observed between 1988-2010 were included. To all patients was ad - ministered a self completed questionnaire with four different scores: intestinal symptoms (IS), systemic symptoms (SS), emotional function (EF), social function (SF) and an overall QoL score. RESULTS: Overall QoL score and three dimen - sions (SS, EF, SF) resulted not significantly dif - ferent in the three groups, except for IS that re - sulted worst in the IRA-Group. According to the activity of disease it appeared that UC and IRA patients with mild activity had an overall QoL score similar to patients with complicated IPAA. A higher statistically different score of overall QoL was observed in patients with UC and IRA with moderate/severe disease. CONCLUSIONS: Results of the study demon - strate that overall QoL score is poorer in patients with UC and IRA with mild activity and in patients with complicated IPAA and is worst in patients with UC and IRA with moderate/severe activity .

Background: Diverticulosis of the colon is an acquired condition that results from herniation of the mucosa through defects in the muscular layer. Several studies have revealed that diverticular formation of the colon occurs primarily in industrialized and Westernized countries. The true prevalence of colonic diverticulosis is difficult to measure because most individuals are asymptomatic. In particularly, in literature, there are few studies about the prevalence of colonic diverticulosis in patients affected by ulcerative colitis (UC). Aim of this study has been to investigate the prevalence of colonic diverticulosis in UC and in adult patients referred in a single centre. Methods: Computerized data of consecutive patients, referred to our Institution to undergo a colonoscopy for colorectal cancer screening and/or for UC control, between January 1, 2009 and December 31, 2009, were retrospectively studied. Results: Six hundred and five consecutive patients, referred to our Institution to undergo a colonoscopy between January 1, 2009 and December 31, 2009, were retrospectively studied. Of these patients, 438 (72.4%) underwent colonoscopy for colorectal cancer screening (Group A) and 167 (27.6%) for UC control (Group B). In group A 224 patients (51.1%) were male (average age of 62.7±14.2 SD years, range 35 86 years), in group B 102 (61.1%) were male (average age of 57.6±12.1 SD years, range 25 84 years). Prevalence of colonic diverticulosis was higher in group A (122 patients, 27.8%) than group B (18 patients, 10.8%) a difference statistically significant (p < 0.0001, Fisher’s exact test). In particularly female gender in patients with colonic diverticulosis was higher in group A than group B (68 patients and 4 patients, respectively) with a difference statistically significant (p < 0.0001, Fisher’s exact test). No differences were found between the two groups in terms of extension of colonic diverticulosis. Conclusions: Results of our study demonstrated that prevalence of colonic diverticulosis was significantly lower in patients with UC than in adult population, emphasizing the relevance of the coexistence of UC and colonic diverticulosis because could make very difficult the clinical management of these patients.

Pouchitis is not a rare complication that develops after an ileal-pouch anastomosis, performed after colectomy in patients refractory to treatment or with complicated ulcerative colitis. This condition may become chronic and unresponsive to medical therapies, including corticosteroids, antibiotics and probiotics. The advent of biological therapies (tumor necrosis factor-α inhibitors) has changed the course of these complications. In particular, in these cases, infliximab (IFX) may represent a safe and effective therapy in order to avoid the subsequent operation for a permanent ileostomy. This article reviews the therapeutic effects of one of the most widely used anti-tumor necrosis factor-α molecules, IFX, for the treatment of complicated pouchitis (refractory to conventional treatment and/or fistulizing).

(age, gender, study level, working status, personal status), data concerning the disease (type of IBD, year of diagnosis, number of hospital admissions, IBD-related surgical procedures), data about therapy (drug, dose, interval), self-applied adhesion declaration and self-medication. An activity index was calculated on the spot (Harvey-Bradshaw/Truelove) Results: Mean age was 41.3±11 years, 60% were women. The number of years since IBD diagnosis was 8±7; 64% were Crohn's disease (71% inactive), 36% ulcerative colitis (70% inactive). A 66% was treated with aminosalicylates, 51%with immunosuppressors, 8% with glucocorticoids. A 66% needed an IBD-related hospital admission in the past, and 17% any IBD-related surgical procedure. A 69% (95%CI: 60-77%) showed some type of non-adhesion. A 66% (57-75%) acknowledged dome degree of involuntary non-adhesion: either forgetting to take their dose (63%) or being careless about having taken it (27%). A 16% (9-22%) showed some kind of voluntary non-adhesion: interrupting the therapy when feeling better (13%) or when feeling worse (6%). A 25% (17-33%) forgot at least a dose a week (mean weekly number of forgotten doses 1.6), and the most frequent cause was to be away form home when they were supposed to take the medication. This was more frequent under mesalazine therapy (30%) than with azathioprine (17%) (p=n.s.). A multivariate analysis identified as risk factors for a lower adhesion the dosing in three or more takes a day (OR 3; 95%CI 1.1-8.4; p= 0.03) and feeling little informed about their disease (OR 4.9; 95%CI 1.1-23.8; p=0.04). On the other hand, immunomodulator therapy was a predictive factor for better adhesion (OR 0.29; 95%CI 0.11-0.74; p=0.01). The concordance between patient recall and clinical records was complete in 86%, whereas in 10.3% the patients did not accurately remember the dose and in 3.7% there was confusion about the drug taken. A 9% acknowledged self-medication during flares Conclusions: In our setting, adhesion to therapy in IBD patients is not satisfactory. Patients treated with immunosuppressors have better adhesion. Optimizing the information on the disease and giving the medication in one or two daily doses could enhance therapeutic adhesion