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1. A holistic evaluation of patients with chronic Hepatitis D virus (HDV) infection enrolled in the Italian PITER-B and delta cohort

Author

Loreta A. Kondili, Giuseppina Brancaccio, Maria Elena Tosti, Barbara Coco, Maria Giovanna Quaranta, Vincenzo Messina, Alessia Ciancio, Filomena Morisco, Valentina Cossiga, Ernesto Claar, Valerio Rosato, Marianna Ciarallo, Irene Cacciola, Francesca Romana Ponziani, Lucia Cerrito, Roberta Coppola, Francesco Longobardi, Elisa Biliotti, Alessia Rianda, Francesco Barbaro, Nicola Coppola, Maria Stanzione, Francesco Barchiesi, Stefano Fagiuoli, Mauro Viganò, Marco Massari, Francesco Paolo Russo, Alberto Ferrarese, Diletta Laccabue, Vito Di Marco, Pierluigi Blanc, Aldo Marrone, Giulia Morsica, Alessandro Federico, Donatella Ieluzzi, Alba Rocco, Francesco Giuseppe Foschi, Alessandro Soria, Ivana Maida, Luchino Chessa, Michele Milella, Elena Rosselli Del Turco, Salvatore Madonia, Liliana Chemello, Ivan Gentile, Pierluigi Toniutto, Matteo Bassetti, Lorenzo Surace, Leonardo Baiocchi, Adriano Pellicelli, Adriano De Santis, Massimo Puoti, Elisabetta Degasperi, Grazia Anna Niro, Anna Linda Zignego, Antonio Craxi, Giovanni Raimondo, Teresa Antonia Santantonio, Maurizia Rossana Brunetto, Giovanni Battista Gaeta, Alessio Aghemo, Chiara Baiguera, Pier Maria Battezzati, Sara Battistella, Maria Grazia Bavetta, Costanza Bertoni, Carolina Boni, Paola Brambilla, Antonella Bray, Federica Briano, Enrico Carmenini, Francesco Castelli, Luisa Cavalletto, Federica Cerini, Luciana Chidichimo, Elisa Colella, Giuliana Cologni, Silvia Como, Romina Corsini, Chiara Costa, Rosa Cotugno, Silvia Cretella, Fernando De Angelis, Pasqualina De Leo, Giovanni Di Perri, Elisabetta Falbo, Luigina Ferrigno, Ezio Fornasiere, Daniela Francisci, Pietro Gatti, Pietro Lampertico, Ilaria Lenci, Anna Licata, Alfredo Marzano, Antonio Mastroianni, Cesare Mazzaro, Monica Monti, Gerardo Nardone, Laura Ambra Nicolini, Nicola Passigato, Maria Bruna Pasticci, Piera Pierotti, Biagio Pinchera, Teresa Pollicino, Carmen Porcu, Giulia Quartini, Gabriele Rancatore, Mario Romeo, Maria Grazia Rumi, Annalisa Saracino, Ornella Schioppa, Ilaria Serio, Roberta Soffredini, Xhimi Tata, Marco Tizzani, Matteo Tonnini, Carlo Torti, Daniela Valenti, Serena Zaltron, and Alessia Zoncada

Subjects
Cohort, IFN treatment, Comorbidities, Infectious and parasitic diseases, RC109-216
Abstract

Background and Aims: We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. Methods: This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. Results: Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. Conclusions: CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.

Published
2024
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2. The professional background of a referring physician predicts the diagnostic yield of small bowel capsule endoscopy in suspected small bowel bleeding

Author

Debora Compare, Costantino Sgamato, Alba Rocco, Pietro Coccoli, Durante Donnarumma, Stefano Andrea Marchitto, Sofia Cinque, Pietro Palmieri, and Gerardo Nardone

Subjects
Endoscopy Small Bowel, Capsule endoscopy, Small intestinal bleeding, Diseases of the digestive system. Gastroenterology, RC799-869
Published
2024
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3. Exploring the Link between Helicobacter pylori, Gastric Microbiota and Gastric Cancer

Author

Costantino Sgamato, Alba Rocco, Debora Compare, Kateryna Priadko, Marco Romano, and Gerardo Nardone

Subjects
gastric cancer, gastric microbiota, H. pylori, Therapeutics. Pharmacology, RM1-950
Abstract

Gastric cancer (GC) still represents one of the leading causes of cancer-related mortality and is a major public health issue worldwide. Understanding the etiopathogenetic mechanisms behind GC development holds immense potential to revolutionize patients’ treatment and prognosis. Within the complex web of genetic predispositions and environmental factors, the connection between Helicobacter pylori (H. pylori) and gastric microbiota emerges as a focus of intense research investigation. According to the most recent hypotheses, H. pylori triggers inflammatory responses and molecular alterations in gastric mucosa, while non-Helicobacter microbiota modulates disease progression. In this review, we analyze the current state of the literature on the relationship between H. pylori and non-Helicobacter gastric microbiota in gastric carcinogenesis, highlighting the mechanisms by which microecological dysbiosis can contribute to the malignant transformation of the mucosa.

Published
2024
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4. Trends in chronic hepatitis B virus infection in Italy over a 10-year period: Clues from the nationwide PITER and MASTER cohorts toward elimination

Author

Giuseppina Brancaccio, Barbara Coco, Alessandra Nardi, Maria Giovanna Quaranta, Maria Elena Tosti, Luigina Ferrigno, Irene Cacciola, Vincenzo Messina, Luchino Chessa, Filomena Morisco, Michele Milella, Francesco Barbaro, Alessia Ciancio, Francesco Paolo Russo, Nicola Coppola, Pierluigi Blanc, Ernesto Claar, Gabriella Verucchi, Massimo Puoti, Anna Linda Zignego, Liliana Chemello, Salvatore Madonia, Stefano Fagiuoli, Alfredo Marzano, Carlo Ferrari, Pietro Lampertico, Vito Di Marco, Antonio Craxì, Teresa Antonia Santantonio, Giovanni Raimondo, Maurizia R. Brunetto, Giovanni Battista Gaeta, Loreta A. Kondili, Luisa Pasulo, Carmine Coppola, Federica Pisano, Mariarosaria Romano, Carmen Porcu, Irene Francesca Bottalico, Valentina Cossiga, Xhimi Tata, Caterina Sagnelli, Piera Pierotti, Elisabetta Degasperi, Valerio Rosato, Lorenzo Badia, Dontella Ieluzzi, Monica Monti, Maria Grazia Bavetta, Luisa Cavalletto, Pierluigi Toniutto, Ezio Fornasiere, Antonio Colecchia, Alberto Ferrarese, Gerardo Nardone, Alba Rocco, Mauro Viganò, Francesco Giuseppe Foschi, Fabio Conti, Giulia Morsica, Stefania Salpietro, Carlo Torti, Chiara Costa, Alessandro Federico, Marcello Dallio, Alessia Giorgini, Marco Anselmo, Pasqualina De Leo, Serena Zaltron, Anna Cambianica, Fabio Piscaglia, Ilaria Serio, Simona Schivazappa, Antonio Mastroianni, Luciana Chidichimo, Marco Massari, Cesare Mazzaro, Aldo Marrone, Francesca Maria D'Amore, Gianpiero D'Offizi, Anna Licata, Grazia Anna Niro, Teresa Pollicino, and Alessio Aghemo

Subjects
Hepatitis B, Chronic, Hepatitis Delta, Epidemiology, Migrants, Hepatitis control, Infectious and parasitic diseases, RC109-216
Abstract

Objectives: The study measures trends in the profile of patients with chronic hepatitis B virus linked to care in Italy. Methods: A cross-sectional, multicenter, observational cohort (PITER cohort) of consecutive patients with hepatitis B surface antigen (HBsAg) over the period 2019-2021 from 46 centers was evaluated. The reference was the MASTER cohort collected over the years 2012-2015. Standard statistical methods were used. Results: The PITER cohort enrolled 4583 patients, of whom 21.8% were non-Italian natives. Compared with those in MASTER, the patients were older and more often female. The prevalence of hepatitis B e antigen (HBeAg) declined (7.2% vs 12.3; P

Published
2023
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5. Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs

Author

Nicola Reggidori, Laura Bucci, Valentina Santi, Benedetta Stefanini, Lorenzo Lani, Davide Rampoldi, Giorgia Ghittoni, Fabio Farinati, Alberto Masotto, Bernardo Stefanini, Andrea Mega, Elisabetta Biasini, Francesco Giuseppe Foschi, Gianluca Svegliati-Baroni, Angelo Sangiovanni, Claudia Campani, Giovanni Raimondo, Gianpaolo Vidili, Antonio Gasbarrini, Ciro Celsa, Mariella Di Marco, Edoardo G. Giannini, Rodolfo Sacco, Maurizia Rossana Brunetto, Francesco Azzaroli, Donatella Magalotti, Filomena Morisco, Gian Ludovico Rapaccini, Gerardo Nardone, Alessandro Vitale, Franco Trevisani, Maurizio Biselli, Paolo Caraceni, Annagiulia Gramenzi, Francesca Benevento, Alessandro Granito, Luca Muratori, Fabio Piscaglia, Francesco Tovoli, Gloria Allegrini, Calogero Cammà, Giuseppe Cabibbo, Carmelo Marco Giacchetto, Paolo Giuffrida, Maria Vittoria Grassini, Mauro Grova, Gabriele Rancatore, Caterina Stornello, Valentina Adotti, Tancredi Li Cavoli, Fabio Marra, Martina Rosi, Vittoria Bevilacqua, Alberto Borghi, Lucia Napoli, Fabio Conti, G.L. Frassineti, Maria Teresa Migliano, Nicoletta de Matthaeis, Francesca Romana Ponziani, Gabriele Missale, Andrea Olivani, Mario Capasso, Valentina Cossiga, Maria Guarino, Ester Marina Cela, Antonio Facciorusso, Camilla Graziosi, Valentina Lauria, Giorgio Pelecca, Marta Schirripa, Fabrizio Chegai, Armando Raso, Alessio Bozzi, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Elton Dajti, Federico Ravaioli, Maria Corina Plaz Torres, Giulia Pieri, Filippo Oliveri, Gabriele Ricco, Veronica Romagnoli, Alessandro Inno, Fabiana Marchetti, Pietro Coccoli, Antonio Malerba, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, and Matteo Renzulli

Subjects
Hepatocellular carcinoma, Alcohol abuse, ITA.LI.CA staging system, Metabolic dysfunction-associated fatty liver disease, Surveillance programs, Oesophageal varices, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background & Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine surveillance and a higher burden of comorbidity in alcohol abusers. This study aimed to describe the evolving clinical scenario of alcohol-related HCC over 15 years (2006–2020) in Italy. Methods: Data from the Italian Liver Cancer (ITA.LI.CA) registry were used: 1,391 patients were allocated to three groups based on the year of HCC diagnosis (2006–2010; 2011–2015; 2016–2020). Patient characteristics, HCC treatment, and overall survival were compared among groups. Survival predictors were also investigated. Results: Approximately 80% of alcohol-related HCCs were classified as cases of metabolic dysfunction-associated fatty liver disease. Throughout the quinquennia,

Published
2023
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6. Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Author

Claudia Campani, Alessandro Vitale, Gabriele Dragoni, Umberto Arena, Giacomo Laffi, Umberto Cillo, Edoardo G. Giannini, Francesco Tovoli, Gian Ludovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Rodolfo Sacco, Giuseppe Cabibbo, Andrea Mega, Maria Guarino, Antonio Gasbarrini, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Elisabetta Biasini, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Maurizia Rossana Brunetto, Fabio Farinati, Franco Trevisani, and Fabio Marra

Subjects
barcelona clinic liver cancer, italica staging system, albi grade, mesiah, cancer of the liver italian program, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Introduction: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. Results: The median OS of the enrolled patients was 41 months. According to LRT χ2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10–1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. Conclusion: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.

Published
2021
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7. Transarterial Chemoembolization for Hepatocellular Carcinoma in Clinical Practice: Temporal Trends and Survival Outcomes of an Iterative Treatment

Author

Filippo Pelizzaro, Selion Haxhi, Barbara Penzo, Alessandro Vitale, Edoardo G. Giannini, Vito Sansone, Gian Ludovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Donatella Magalotti, Rodolfo Sacco, Ciro Celsa, Claudia Campani, Andrea Mega, Maria Guarino, Antonio Gasbarrini, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Andrea Olivani, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Maurizia Rossana Brunetto, Franco Trevisani, and Fabio Farinati

Subjects
hepatocellular carcinoma, transarterial chemoembolization, survival, iterative treatment, therapeutic hierarchy, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

BackgroundTransarterial chemoembolization (TACE) is one of the most frequently applied treatments for hepatocellular carcinoma (HCC) worldwide. In this study, we aimed at evaluating whether and how TACE application and repetition, as well as the related outcome, have changed over the last three decades in Italy.MethodsData of 7,184 patients with HCC were retrieved from the Italian Liver Cancer (ITA.LI.CA) database. Patients were divided according to the period of diagnosis in six cohorts: P1 (1988–1993), P2 (1994–1998), P3 (1999–2004), P4 (2005–2009), P5 (2010–2014), and P6 (2015–2019). All the analyses were repeated in the overall patient population and in Barcelona Clinic Liver Cancer (BCLC) B patients, who are the subgroup of HCC patients originally supposed to receive TACE according to guidelines. TACE was defined as either the first or the main (more effective) treatment.ResultsThe proportion of patients receiving TACE as first or main therapy declined over time, and less than 50% of BCLC B patients were treated with chemoembolization from P3 onward. Conversely, TACE was widely used even outside the intermediate stage. Survival of TACE-treated patients progressively increased from P1 to P6. Although TACE was performed only once in the majority of patients, there was an increasing proportion of those receiving 2 or ≥3 treatments sessions over time. The overall survival (OS) of patients undergoing repeated treatments was significantly higher compared to those managed with a single TACE (median OS 40.0 vs. 65.0 vs. 71.8 months in 1, 2, and ≥3 TACE groups, respectively; p < 0.0001). However, after a first-line TACE, the adoption of curative therapies provided longer survival than repeating TACE (83.0 vs. 42.0 months; p < 0.0001), which in turn was associated with better outcomes compared to systemic therapies or best supportive care (BSC).ConclusionsDespite a decline in the percentage of treated patients over time, TACE has still an important role in the management of HCC patients. The survival of TACE-treated patients gradually improved over time, probably due to a better patient selection. Iterative TACE is effective, but an upward shift to curative therapies provides better outcomes while transition to systemic therapies and BSC leads to a worse prognosis.

Published
2022
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8. Gut Microbes and Hepatic Encephalopathy: From the Old Concepts to New Perspectives

Author

Alba Rocco, Costantino Sgamato, Debora Compare, Pietro Coccoli, Olga Maria Nardone, and Gerardo Nardone

Subjects
hepatic encephalopathy, gut microbes, gut-liver-brain axis, antibiotics, probiotics, fecal microbiota transplantation, Biology (General), QH301-705.5
Abstract

Hepatic encephalopathy (HE) is a severe complication of advanced liver disease and acute liver failure. The clinical spectrum ranges from minor cognitive dysfunctions to lethargy, depressed consciousness, and coma and significantly impact the quality of life, morbidity, and mortality of the patients. It is commonly accepted that the gut milieu is essential for the development of HE; however, despite intensive research efforts, the pathogenesis of HE is still not fully elucidated. As our knowledge of gut microbiota moves from the pioneering era of culture-dependent studies, the connection between microbes, inflammation, and metabolic pathways in the pathogenesis of HE is becoming increasingly clear, providing exciting therapeutic perspectives. This review will critically examine the latest research findings on the role of gut microbes in the pathophysiological pathways underlying HE. Moreover, currently available therapeutic options and novel treatment strategies are discussed.

Published
2021
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9. Blinded Oral Challenges with Lactose and Placebo Accurately Diagnose Lactose Intolerance: A Real-Life Study

Author

Alba Rocco, Debora Compare, Costantino Sgamato, Alberto Martino, Luca De Simone, Pietro Coccoli, Maria Laura Melone, and Gerardo Nardone

Subjects
lactose malabsorption, lactose intolerance, placebo challenge, hydrogen breath test, Nutrition. Foods and food supply, TX341-641
Abstract

Lactose intolerance (LI) is characterized by diarrhea, abdominal pain, or bloating occurring after lactose consumption in patients with lactose malabsorption. The National Institute of Health (NIH) proposed a double-blind placebo testing to identify LI individuals correctly. However, until now, no study used this approach in a real-life setting. We aimed to assess double-blind placebo challenge accuracy in diagnosing LI in patients with self-reported symptoms of LI. 148 patients with self-reported LI were consecutively enrolled and blindly underwent hydrogen breath test (HBT) after 25 g lactose or 1 g glucose (placebo) load. One week later, the subjects were challenged with the alternative substrate. Each subject completed a validated questionnaire, including five symptoms (diarrhea, abdominal pain, vomiting, bowel sounds, and bloating) scored on a 10-cm visual analog scale. Home questionnaire (HQ) referred to symptoms associated with the consumption of dairy products at home, while lactose questionnaire (LQ) and placebo questionnaire (PQ) referred to symptoms perceived throughout the 4-h after the administration of the substrates, respectively. After lactose load, HBT was positive in 81 patients (55%), of whom 60 (74%) reported relevant symptoms at LQ (lactose malabsorbers, LM). After placebo challenge, 45 out of 60 with a positive lactose challenge did not complain of symptoms and therefore were diagnosed as lactose intolerant, according to NIH definition. The blinded oral challenges with lactose and placebo accurately diagnose LI and identify patients who will likely benefit from a lactose-free diet.

Published
2021
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10. A Nomogram-Based Prognostic Model for Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib: A Multicenter Study

Author

Giovanni Marasco, Francesco Poggioli, Antonio Colecchia, Giuseppe Cabibbo, Filippo Pelizzaro, Edoardo Giovanni Giannini, Sara Marinelli, Gian Ludovico Rapaccini, Eugenio Caturelli, Mariella Di Marco, Elisabetta Biasini, Fabio Marra, Filomena Morisco, Francesco Giuseppe Foschi, Marco Zoli, Antonio Gasbarrini, Gianluca Svegliati Baroni, Alberto Masotto, Rodolfo Sacco, Giovanni Raimondo, Francesco Azzaroli, Andrea Mega, Gianpaolo Vidili, Maurizia Rossana Brunetto, Gerardo Nardone, Luigina Vanessa Alemanni, Elton Dajti, Federico Ravaioli, Davide Festi, Franco Trevisani, and on behalf of the Italian Liver Cancer (ITA.LI.CA.) Group

Subjects
sorafenib, hepatocellular carcinoma, survival, prognosis, cohort study, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Among scores and staging systems used for HCC, none showed a good prognostic ability in patients with advanced HCC treated with Sorafenib. We aimed to evaluate predictive factors of overall survival (OS) and drug response in HCC patients undergoing Sorafenib included in the Italian Liver Cancer (ITA.LI.CA.) multicenter cohort. Patients in the ITA.LI.CA database treated with Sorafenib and updated on 30 June 2019 were included. Demographic and clinical data before starting Sorafenib treatment were considered. For the evaluation of predictive factors for OS, a time-dependent Cox proportional hazard model was used. A total of 1107 patients were included in our analysis. The mean age was 64.3 years and 81.7% were male. Most patients were staged as BCLC B (205, 18.9%) or C (706, 65.1%). The median time of Sorafenib administration was 4 months (interquartile range (IQR) 2–12), and the median OS was 10 months (IQR: 4–20). A total of 263 patients (33.8%) out of 780 with available evaluation experienced objective tumoral response to Sorafenib. The Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) (hazard ratio (HR) 1.284), maximum tumoral diameter (HR 1.100), plasma total bilirubin (HR 1.119), aspartate amino transferase assessed as multiple of the upper normal value (HR 1.032), alpha-fetoprotein ≥200 ng/mL (HR 1.342), hemoglobin (HR 0.903) and platelet count (HR 1.002) were associated with OS at multivariate Cox regression analysis. Drug response was predicted by maximum tumoral diameter and platelet count. A novel prognostic nomogram for patients undergoing Sorafenib is hereby proposed. The novelty introduced is the comprehensive patient’s assessment using common markers of patient’s general status, liver damage and function and HCC biology. Further studies are required to test its accuracy and provide external validation.

Published
2021
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11. Lactobacillus casei DG and its postbiotic reduce the inflammatory mucosal response: an ex-vivo organ culture model of post-infectious irritable bowel syndrome

Author

Debora Compare, Alba Rocco, Pietro Coccoli, Debora Angrisani, Costantino Sgamato, Barbara Iovine, Umberto Salvatore, and Gerardo Nardone

Subjects
Post-infectious irritable bowel syndrome, Probiotics, Postbiotic, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Abstract Background The evidence on the role of gut microbiota in post-infectious irritable bowel syndrome (PI-IBS) is convincing. Lactobacillus spp. positively affect IBS symptoms, although the mechanisms through which probiotics exert their beneficial effects are largely unknown. The aim of the study is to evaluate the role of Lactobacillus casei DG (LC-DG) and its postbiotic (PB) in modulating the inflammatory/immune-response in PI-IBS in an ex-vivo organ culture model. Methods Ex vivo cultures of ileal and colonic mucosa from 10 PI-IBS, diarrhea predominant subtype (D) patients, and 10 healthy controls (HC) were treated with LPS, LC-DG and PB. Interleukin (IL)-1α, IL-6, IL-8 and IL-10 mRNA levels were assessed by real-time PCR and Toll like receptor 4 (TLR-4) protein expression by Western blotting. Results At baseline, IL-1α, IL-6 and IL-8 mRNA levels as well as TLR-4 protein expression were significantly higher while IL-10 mRNA levels were lower in PI-IBS D than in HC in both ileum and colon. LC-DG and PB significantly reduced the mRNA levels of pro-inflammatory cytokines and TLR-4 while increased that of IL-10 after LPS stimulation. The protective effect was more pronounced for PB than LC-DG treatment. Conclusion LC-DG and its PB attenuate the inflammatory mucosal response in an ex-vivo organ culture model of PI-IBS D.

Published
2017
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12. Invasive pulmonary aspergillosis and pulmonary tuberculosis in a patient treated with infliximab for Crohn’s disease

Author

Antonio Riccardo Buonomo, Giulio Viceconte, Debora Compare, Maria Vargas, Carmine Iacovazzo, Emanuela Zappulo, Gerardo Nardone, Giuseppe Servillo, Guglielmo Borgia, and Ivan Gentile

Subjects
Infectious and parasitic diseases, RC109-216
Abstract

We report a case of concurrent development of active pulmonary tuberculosis and invasive pulmonary aspergillosis (IPA) in a patient who received therapy with infliximab for Crohn’s disease. He has been treated with antitubercular therapy and liposomal amphotericin B for 8 weeks. His clinical course was complicated by paroxysmal atrial fibrillation requiring maintenance therapy with amiodarone, respiratory failure due both to pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamases (ESBL)-producing Klebsiella pneumoniae and pleural effusion requiring chest drainage. At discharge, a maintenance regimen based on the administration of isavuconazole 200 mg daily, moxifloxacin 400 mg daily and isoniazid 300 mg daily was chosen to avoid multiple drug-drug interaction between rifamycins, antifungal triazole agents and antiarrhythmic drugs. At 3 months of follow-up his clinical conditions were dramatically improved, high resolution chest tomography (HRCT) showed reduction of parenchymal lesions and no changes both in sinus rhythm and QTc interval were noticed. Besides the complexity and the peculiarity of the clinical scenario, this case underlines the risk of invasive fungal infections linked to the administration of TNF-α antagonists in gastroenterological setting and the importance of accurate evaluation of drug-drug interactions when choosing the antimicrobial therapies. Keywords: Invasive pulmonary aspergillosis, Tuberculosis, Infliximab, Isavuconazole

Published
2019
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13. Identification of Clinical Phenotypes and Related Survival in Patients with Large HCCs

Author

Brian I. Carr, Vito Guerra, Rossella Donghia, Fabio Farinati, Edoardo G. Giannini, Luca Muratori, Gian Ludovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Rodolfo Sacco, Ciro Celsa, Claudia Campani, Andrea Mega, Maria Guarino, Antonio Gasbarrini, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Elisabetta Biasini, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Maurizia Rossana Brunetto, and Franco Trevisani

Subjects
HCC, large, phenotypes, PVT, multifocality, albumin, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin >3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (

Published
2021
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14. Duodenal Metatranscriptomics to Define Human and Microbial Functional Alterations Associated with Severe Obesity: A Pilot Study

Author

Ilaria Granata, Carmela Nardelli, Valeria D’Argenio, Salvatore Tramontano, Debora Compare, Mario Rosario Guarracino, Gerardo Nardone, Vincenzo Pilone, and Lucia Sacchetti

Subjects
metatranscriptomics, microbial-host duodenal transcriptome, human obesity, metabolism, Biology (General), QH301-705.5
Abstract

Obesity is a multifactorial disorder, and the gut microbiome has been suggested to contribute to its onset. In order to better clarify the role of the microbiome in obesity, we evaluated the metatranscriptome in duodenal biopsies from a cohort of 23 adult severely obese and lean control subjects using next generation sequencing. Our aim was to provide a general picture of the duodenal metatranscriptome associated with severe obesity. We found altered expressions of human and microbial genes in the obese compared to lean subjects, with most of the gene alterations being present in the carbohydrate, protein, and lipid metabolic pathways. Defects were also present in several human genes involved in epithelial intestinal cells differentiation and function, as well as in the immunity/inflammation pathways. Moreover, the microbial taxa abundance inferred by our transcriptomic data differed in part from the data that we previously evaluated by 16S rRNA in 13/23 individuals of our cohort, particularly concerning the Firmicutes and Proteobacteria phyla abundances. In conclusion, our pilot study provides the first taxonomic and functional characterization of duodenal microbiota in severely obese subjects and lean controls. Our findings suggest that duodenal microbiome and human genes both play a role in deregulating metabolic pathways, likely affecting energy metabolism and thus contributing to the obese phenotype.

Published
2020
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15. Characterization of the Duodenal Mucosal Microbiome in Obese Adult Subjects by 16S rRNA Sequencing

Author

Carmela Nardelli, Ilaria Granata, Valeria D'Argenio, Salvatore Tramontano, Debora Compare, Mario Rosario Guarracino, Gerardo Nardone, Vincenzo Pilone, and Lucia Sacchetti

Subjects
obesity, duodenum, microbiome, Biology (General), QH301-705.5
Abstract

The gut microbiota may have an impact on obesity. To date, the majority of studies in obese patients reported microbiota composition in stool samples. The aim of this study was to investigate the duodenal mucosa dysbiosis in adult obese individuals from Campania, a region in Italy with a very high percentage of obese people, to highlight microbial taxa likely associated with obesity. Duodenum biopsies were taken during upper gastrointestinal endoscopy in 19 obese (OB) and 16 lean control subjects (CO) and microbiome studied by 16S rRNA gene sequencing. Duodenal microbiome in our groups consisted of six phyla: Proteobacteria, Firmicutes, Actinobacteria, Fusobacteria, Bacteroidetes and Acidobacteria. Proteobacteria (51.1% vs. 40.1%) and Firmicutes (33.6% vs. 44.9%) were significantly (p < 0.05) more and less abundant in OB compared with CO, respectively. Oribacterium asaccharolyticum, Atopobium parvulum and Fusobacterium nucleatum were reduced (p < 0.01) and Pseudomonadales were increased (p < 0.05) in OB compared with CO. Receiver operating characteristic curve analysis showed Atopobium and Oribacterium genera able to discriminate with accuracy (power = 75% and 78%, respectively) OB from CO. In conclusion, increased Proteobacteria and decreased Firmicutes (Lachnospiraceae) characterized the duodenal microbiome of obese subjects. These data direct to further studies to evaluate the functional role of the dysbiotic-obese-associated signature.

Published
2020
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16. Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease.

Author

Marcello Mancini, Angelo Salomone Megna, Monica Ragucci, Massimo De Luca, Giuseppina Marino Marsilia, Gerardo Nardone, Pietro Coccoli, Anna Prinster, Lorenzo Mannelli, Emilia Vergara, Serena Monti, Raffaele Liuzzi, and Mariarosaria Incoronato

Subjects
Medicine, Science
Abstract

The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The aim of the study was to determine reproducibility of real-time shear wave elastography using a hepatic biopsy as the reference standard to identify patients with chronic liver disease. Forty patients with chronic liver disease and 12 normal subjects received shear wave elastography performed by skilled operators. Interoperator reproducibility was studied in 29 patients. Fibrosis was evaluated using the Metavir score. The median and range shear wave elastography values in chronic liver disease subjects were 6.15 kPa and 3.14-16.7 kPa and were 4.49 kPa and 2.92-7.32 kPa in normal subjects, respectively. With respect to fibrosis detected by liver biopsy, shear wave elastography did not change significantly between F0 and F1 (p = 0.334), F1 and F2 (p = 0.611), or F3 and F4 (0.327); a significant difference was observed between the F0-F2 and F3-F4 groups (p = 0.002). SWE also correlated with inflammatory activity (Rs = 0.443, p = 0.0023) and ALT levels (Rs = 0.287, p = 0.0804). Age, sex and body mass index did not affect shear wave elastography measurements. Using receiver operator characteristic curves, two threshold values for shear wave elastography were identified: 5.62 kPa for patients with fibrosis (≥F2; sensitivity 80%, specificity 69.4%, and accuracy 77%) and 7.04 kPa for patients with severe fibrosis (≥F3; sensitivity 88.9%, specificity 81%, and accuracy 89%). Overall interobserver agreement was excellent and was analysed using an interclass correlation coefficient (0.94; CI 0.87-0.97).This study shows that shear wave elastography executed by skilled operators can be performed on almost all chronic liver disease patients with high reproducibility. It is not influenced by age, sex or body mass index, identifies severely fibrotic patients and is also related to inflammatory activity.

Published
2017
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17. Gastric Normal Adjacent Mucosa Versus Healthy and Cancer Tissues: Distinctive Transcriptomic Profiles and Biological Features

Author

Sabino Russi, Giovanni Calice, Vitalba Ruggieri, Simona Laurino, Francesco La Rocca, Elena Amendola, Cinzia Lapadula, Debora Compare, Gerardo Nardone, Pellegrino Musto, Mario De Felice, Geppino Falco, and Pietro Zoppoli

Subjects
gastric cancer, normal tissue adjacent to the tumor, gene expression profile, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Gastric cancer (GC) is a leading cause of cancer-related deaths in the world. Molecular heterogeneity is a major determinant for the clinical outcomes and an exhaustive tumor classification is currently missing. Histologically normal tissue adjacent to the tumor (NAT) is commonly used as a control in cancer studies, nevertheless a recently published paper described the unique characteristics of the NAT in several tumor types. Little is known about the global gene expression profile of gastric NAT (gNAT) which could be an effective tool for a more realistic definition of GC molecular signature. Here, we integrated data of 512 samples from the Genotype-Tissue Expression project (GETx) and The Cancer Genome Atlas (TCGA) to analyze the transcriptome of healthy gastric tissues, gNAT, and GC samples. We validated TCGA-GETx data mining through inHouse gNAT and GC expression dataset. Differential gene expression together with pathway enrichment analyses, indeed, led to different results when using the gNAT or the healthy tissue as control. Based on our analyses, gNAT showed a peculiar gene signature and biological features, like the estrogen receptor pathways activation, suggesting a molecular behavior partially different from both healthy and GC tissues. Therefore, using gNAT as healthy control tissue in the characterization of tumor associated biological processes and pathways could lead to suboptimal results.

Published
2019
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18. Non-Steroidal Anti-Inflammatory Drugs in the Carcinogenesis of the Gastrointestinal Tract

Author

Gerardo Nardone, Olga Nardone, and Debora Compare

Subjects
cyclooxygenase-2, non-steroidal anti-inflammatory drugs, esophageal cancer, gastric cancer, colorectal cancer, Medicine, Pharmacy and materia medica, RS1-441
Abstract

It is estimated that underlying infections and inflammatory responses are linked to 15–20% of all deaths from cancer worldwide. Inflammation is a physiologic process in response to tissue damage resulting from microbial pathogen infection, chemical irritation, and/or wounding. Tissues injured throughout the recruitment of inflammatory cells such as macrophages and neutrophils, generate a great amount of growth factors, cytokines, and reactive oxygen and nitrogen species that may cause DNA damage that in turn predisposes to the transformation from chronic inflammation to neoplasia. Cyclooxygenase (COX), playing a key role in cell homeostasis, angiogenesis and tumourigenesis, may represent the link between inflammation and cancer. Currently COX is becoming a pharmacological target for cancer prevention and treatment.It is estimated that underlying infections and inflammatory responses are linked to 15–20% of all deaths from cancer worldwide. Inflammation is a physiologic process in response to tissue damage resulting from microbial pathogen infection, chemical irritation, and/or wounding. Tissues injured throughout the recruitment of inflammatory cells such as macrophages and neutrophils, generate a great amount of growth factors, cytokines, and reactive oxygen and nitrogen species that may cause DNA damage that in turn predisposes to the transformation from chronic inflammation to neoplasia. Cyclooxygenase (COX), playing a key role in cell homeostasis, angiogenesis and tumourigenesis, may represent the link between inflammation and cancer. Currently COX is becoming a pharmacological target for cancer prevention and treatment.

Published
2010
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19. The Metabolic Role of Gut Microbiota in the Development of Nonalcoholic Fatty Liver Disease and Cardiovascular Disease

Author

Marco Sanduzzi Zamparelli, Debora Compare, Pietro Coccoli, Alba Rocco, Olga Maria Nardone, Giuseppe Marrone, Antonio Gasbarrini, Antonio Grieco, Gerardo Nardone, and Luca Miele

Subjects
gut microbiota, cardiovascular disease, NAFLD, Biology (General), QH301-705.5, Chemistry, QD1-999
Abstract

The prevalence of metabolic disorders, such as type 2 diabetes (T2D), obesity, and non-alcoholic fatty liver disease (NAFLD), which are common risk factors for cardiovascular disease (CVD), has dramatically increased worldwide over the last decades. Although dietary habit is the main etiologic factor, there is an imperfect correlation between dietary habits and the development of metabolic disease. Recently, research has focused on the role of the microbiome in the development of these disorders. Indeed, gut microbiota is implicated in many metabolic functions and an altered gut microbiota is reported in metabolic disorders. Here we provide evidence linking gut microbiota and metabolic diseases, focusing on the pathogenetic mechanisms underlying this association.

Published
2016
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20. Autoimmune liver diseases and SARS-CoV-2

Author

Costantino Sgamato, Alba Rocco, Debora Compare, Stefano Minieri, Stefano Andrea Marchitto, Simone Maurea, and Gerardo Nardone

Subjects
Gastroenterology, General Medicine
Published
2023

21. Effectiveness of first and second‐line empirical treatment in Italy: Results of the European registry on Helicobacter pylori management

Author

Luigi Gatta, Olga P. Nyssen, Giulia Fiorini, Ilaria Maria Saracino, Matteo Pavoni, Marco Romano, Antonietta Gerarda Gravina, Lucia Granata, Rinaldo Pellicano, Antonio Gasbarrini, Alfredo Di Leo, Giuseppe Losurdo, Francesco Franceschi, Gerardo Nardone, Alba Rocco, Maria Pina Dore, Fabio Farinati, Matteo Ghisa, Massimo Bellini, John Holton, Ignasi Puig, Dino Vaira, Claudio Borghi, Francis Mégraud, Colm O'Morain, Javier P. Gisbert, and Gatta L, Nyssen OP, Fiorini G, Saracino IM, Pavoni M, Romano M, Gravina AG, Granata L, Pellicano R, Gasbarrini A, Di Leo A, Losurdo G, Franceschi F, Nardone G, Rocco A, Dore MP, Farinati F, Ghisa M, Bellini M, Holton J, Puig I, Vaira D, Borghi C, Mégraud F, O'Morain C, Gisbert JP

Subjects
Oncology, Hp-EuReg, proton pump inhibitor, Settore MED/12 - GASTROENTEROLOGIA, second-line treatment, Gastroenterology, first-line treatment, H. pylori
Abstract

Background and aims: The optimal management of naïve and not naïve Helicobacter pylori patients remains unclear. Therefore, it is essential to evaluate whether the actual clinical practice mirrors the indications suggested by the guidelines. This study aimed to assess the effectiveness and the safety of the empirical first- and second-line treatments prescribed to patients enroled at Italian centres participating in the European Registry on H. pylori Management (Hp-EuReg). Methods: The Hp-EuReg is an international multicentre prospective non-interventional registry starting in 2013 aiming to evaluate the management of H. pylori infection by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables assessed included demographics, previous eradication attempts, treatment regimen, effectiveness, and tolerance. Results: Overall, 3723 patients from 2013 to February 2021 were included: 2996 and 727 received an empirical first- and second-line treatment, respectively. According to the modified ITT analysis, among the first-line regimens, only the bismuth quadruple therapy with three-in-one-single capsule (BQT-TSC), the concomitant, and the sequential treatment - all lasting 10 days - achieved an eradication rate >90%. Among the second-line regimens, only the 10-day BQT-TSC reported an effectiveness >90%. High-dose PPI twice daily also significantly increased the effectiveness of some therapies. The BQT-TSC was the regimen with the highest incidence of adverse events. Conclusions: Only quadruple therapies lasting at least 10 days achieved over 90% eradication rates among the empirical first- and second-line regimens. It remains unclear whether high-dose PPI twice daily can improve the efficacy of quadruple treatment.

Published
2022

22. Potential feasibility of atezolizumab-bevacizumab therapy in patients with hepatocellular carcinoma treated with tyrosine-kinase inhibitors

Author

Benedetta Stefanini, Laura Bucci, Valentina Santi, Nicola Reggidori, Davide Rampoldi, Lorenzo Lani, Alessandro Granito, Angelo Sangiovanni, Giuseppe Cabibbo, Fabio Farinati, Claudia Campani, Francesco Giuseppe Foschi, Gianluca Svegliati-Baroni, Giovanni Raimondo, Antonio Gasbarrini, Andrea Mega, Elisabetta Biasini, Rodolfo Sacco, Filomena Morisco, Eugenio Caturelli, Gianpaolo Vidili, Francesco Azzaroli, Edoardo G. Giannini, Gian Ludovico Rapaccini, Maurizia Rossana Brunetto, Alberto Masotto, Gerardo Nardone, Mariella Di Marco, Donatella Magalotti, Franco Trevisani, Maurizio Biselli, Paolo Caraceni, Annagiulia Gramenzi, Francesco Tovoli, Luca Muratori, Francesca Benevento, Gloria Allegrini, Calogero Cammà, Ciro Celsa, Paolo Giuffrida, Caterina Stornello, Mauro Grova, Carmelo Marco Giacchetto, Gabriele Rancatore, Maria Vittoria Grassini, Valentina Adotti, Stefano Gitto, Fabio Marra, Martina Rosi, Vittoria Bevilacqua, Alberto Borghi, Andrea Casadei Gardini, Fabio Conti, Anna Chiara Dall'Aglio, Giorgio Ercolani, Federica Mirici, Nicoletta de Matthaeis, Francesca Romana Ponziani, Gabriele Missale, Andrea Olivani, Maria Guarino, Valentina Cossiga, Mario Capasso, Ester Marina Cela, Antonio Facciorusso, Valentina Lauria, Giorgia Ghittoni, Giorgio Pelecca, Fabrizio Chegai, Fabio Coratella, Mariano Ortenzi, Serena Dell'Isola, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Elton Dajti, Federico Ravaioli, Giulia Pieri, Maria Corina Plaz Torres, Filippo Oliveri, Gabriele Ricco, Veronica Romagnoli, Alessandro Inno, Fabiana Marchetti, Pietro Coccoli, Antonio Malerba, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, null Matteo Renzulli, Stefanini, B., Bucci, L., Santi, V., Reggidori, N., Rampoldi, D., Lani, L., Granito, A., Sangiovanni, A., Cabibbo, G., Farinati, F., Campani, C., Foschi, F. G., Svegliati-Baroni, G., Raimondo, G., Gasbarrini, A., Mega, A., Biasini, E., Sacco, R., Morisco, F., Caturelli, E., Vidili, G., Azzaroli, F., Giannini, E. G., Rapaccini, G. L., Brunetto, M. R., Masotto, A., Nardone, G., Di Marco, M., Magalotti, D., Trevisani, F., Biselli, M., Caraceni, P., Gramenzi, A., Tovoli, F., Muratori, L., Benevento, F., Allegrini, G., Camma, C., Celsa, C., Giuffrida, P., Stornello, C., Grova, M., Giacchetto, C. M., Rancatore, G., Grassini, M. V., Adotti, V., Gitto, S., Marra, F., Rosi, M., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Dall'Aglio, A. C., Ercolani, G., Mirici, F., de Matthaeis, N., Ponziani, F. R., Missale, G., Olivani, A., Guarino, M., Cossiga, V., Capasso, M., Cela, E. M., Facciorusso, A., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Dell'Isola, S., Franze, M. S., Saitta, C., Sauchella, A., Dajti, E., Ravaioli, F., Pieri, G., Torres, M. C. P., Oliveri, F., Ricco, G., Romagnoli, V., Inno, A., Marchetti, F., Coccoli, P., Malerba, A., Cappelli, A., Golfieri, R., Mosconi, C., Matteo, Renzulli, Stefanini, Benedetta, Bucci, Laura, Santi, Valentina, Reggidori, Nicola, Rampoldi, Davide, Lani, Lorenzo, Granito, Alessandro, Sangiovanni, Angelo, Cabibbo, Giuseppe, Farinati, Fabio, Campani, Claudia, Foschi, Francesco Giuseppe, Svegliati-Baroni, Gianluca, Raimondo, Giovanni, Gasbarrini, Antonio, Mega, Andrea, Biasini, Elisabetta, Sacco, Rodolfo, Morisco, Filomena, Caturelli, Eugenio, Vidili, Gianpaolo, Azzaroli, Francesco, Giannini, Edoardo G, Rapaccini, Gian Ludovico, Brunetto, Maurizia Rossana, Masotto, Alberto, Nardone, Gerardo, Di Marco, Mariella, Magalotti, Donatella, and Trevisani, Franco

Subjects
Atezolizumab-bevacizumab, Clinical Trials as Topic, Antineoplastic Combined Chemotherapy Protocol, Carcinoma, Hepatocellular, Systemic therapy, Hepatology, Hepatocellular carcinoma, Tirosin-kinase inhibitor, Liver Neoplasms, Gastroenterology, Bevacizumab, Feasibility Studie, Tyrosine, Human
Abstract

Background: The combination of atezolizumab-bevacizumab has been proven to be superior to sorafenib for the treatment of unresectable hepatocellular carcinoma not amenable to locoregional treatments, be-coming the standard of care of systemic therapy.Aim: This study aimed at assessing real-world feasibility of atezolizumab-bevacizumab in patients treated with tyrosine-kinase inhibitors.Methods: Among 1447 patients treated with tyrosine-kinase inhibitors from January 2010 to December 2020, we assessed the percentage of those potentially eligible to atezolizumab-bevacizumab (according to IMbrave-150 trial criteria), and the overall survival of eligible and non-eligible patients.Results: 422 (29%) patients were qualified for atezolizumab-bevacizumab therapy. The main exclusion causes were Child-Pugh class and Performance Status. Adopting the more permissive inclusion criteria of SHARP trial, 535 patients became eligible. The median overall survival of tyrosine-kinase inhibitors patients was 14.9 months, longer in eligible patients than in their counterpart due to better baseline liver function and oncological features.Conclusion: Real-world data indicate that less than one-third of hepatocellular carcinoma patients treated with tyrosine-kinase inhibitors are potentially eligible to atezolizumab-bevacizumab according to the reg-istration trial criteria. These patients have a longer survival than the non-eligible ones. If the selection criteria of atezolizumab-bevacizumab trial are maintained in clinical practice, tyrosine-kinase inhibitors will remain the most used systemic therapy for hepatocellular carcinoma patients.(c) 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Published
2022

23. Wernicke Encephalopathy in Ulcerative Colitis

Author

Roberto de Sire, Antonio Rispo, Debora Compare, Fabio Tortora, Gerardo Nardone, Fabiana Castiglione, De Sire, R., Rispo, A., Compare, D., Tortora, F., Nardone, G., and Castiglione, F.

Subjects
IBD, Gastroenterology, gut-brain axi, Immunology and Allergy, Humans, Colitis, Ulcerative, Wernicke Encephalopathy, malnutrition, ulcerative coliti, Human
Published
2022

24. Course of the Diverticular Disease: What is changing?

Author

Carmelo Scarpignato, Adi Lahat, Giovanni Barbara, Angel Lanas, Valerio Papa, Tomica Milosavljeviĉ, Giovanni Brandimarte, Antonio Tursi, Gerardo Nardone, Neil Stollman, Milasavljevic, T., Brandimarte, G., Stollman, N., Barbara, G., Lahat, A., Scarpignato, C., Lanas, A., Papa, V., Tursi, A., Nardone, G., Milasavljevic T., Brandimarte G., Stollman N., Barbara G., Lahat A., Scarpignato C., Lanas A., Papa V., Tursi A., and Nardone G.

Subjects
medicine.medical_specialty, Diverticular Disease, Settore MED/18 - CHIRURGIA GENERALE, Colonoscopy, Segmental colitis associated with diverticulosi, Disease, Diagnosis, Differential, Irritable Bowel Syndrome, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Mesalazine, Risk Factors, Internal medicine, Diagnosis, Secondary Prevention, medicine, Humans, Diverticulitis, Diverticuliti, Irritable bowel syndrome, Diverticular Diseases, medicine.diagnostic_test, business.industry, Risk Factor, Gastroenterology, food and beverages, medicine.disease, Colorectal cancer, 3. Good health, Rifaximin, Diverticulosis, chemistry, 030220 oncology & carcinogenesis, Differential, Acute Disease, Disease Progression, Diverticular disease, 030211 gastroenterology & hepatology, Segmental colitis associated with diverticulosis, business, Human
Abstract

In this session several critical issues in diverticular disease were considered, including “It is Symptomatic Diverticular Disease or Irritable Bowel Syndrome?”, “What do determine evolution to diverticulitis, bowel habits alteration or inflammation?”, and “Prevention of acute diverticulitis: Is it at all possible?”. The first talking compared symptoms and laboratory findings between Symptomatic Uncomplicated Diverticular Disease (SUDD) and Irritable Bowel Syndrome (IBS). Although both disease share some symptoms, and although IBS can occur in patients having diverticulosis, SUDD and IBS can be differentiate using a combination of symptoms and laboratory tools. The second talking debated what are the most important risk factors for the evolution towards acute diverticulitis. Current data seem to exclude a significant role of bowel habits alteration, while inflammation seems to have a stronger role, especially in causing acute diverticulitis recurrence. The third talking analyzed about the acute diverticulitis prevention. Primary prevention seem to be little better when using mesalazine, while no definite conclusion can be drawn about the use of fiber and rifaximin. About the secondary prevention, no drugs can be currently advised due to lacking of definite results. At the same time, surgery should be advised on case-by-case basis.

Published
2020

25. Biomarkers

Author

Debora Compare, Kok-Ann Gwee, and Gerardo Nardone

Published
2022

26. Characteristics and survival of patients with primary biliary cholangitis and hepatocellular carcinoma

Author

Edoardo G. Giannini, Giulia Pieri, Sara Labanca, Maria Corina Plaz Torres, Antonio Gasbarrini, Elisabetta Biasini, Claudia Campani, Nora Cazzagon, Francesco Giuseppe Foschi, Andrea Mega, Alberto Masotto, Giovanni Raimondo, Gian Ludovico Rapaccini, Rodolfo Sacco, Eugenio Caturelli, Maria Guarino, Francesco Tovoli, Gianpaolo Vidili, Maurizia Rossana Brunetto, Gerardo Nardone, Gianluca Svegliati-Baroni, Donatella Magalotti, Francesco Azzaroli, Giuseppe Cabibbo, Maria Di Marco, Angelo Sangiovanni, Franco Trevisani, Maurizio Biselli, Paolo Caraceni, Annagiulia Gramenzi, Francesca Benevento, Alessandro Granito, Luca Muratori, Fabio Piscaglia, Federica Bertellini, Fabio Farinati, Giorgio Palano, Filippo Pelizzaro, Barbara Penzo, Elisa Pinto, Gloria Allegrini, Calogero Cammà, Ciro Celsa, Paolo Giuffrida, Caterina Stornello, Mauro Grova, Carmelo Marco Giacchetto, Gabriele Rancatore, Maria Vittoria Grassini, Valentina Adotti, Stefano Gitto, Fabio Marra, Martina Rosi, Vittoria Bevilacqua, Alberto Borghi, Andrea Casadei Gardini, Fabio Conti, Lucia Napoli, Marco Domenicali, Maria Teresa Migliano, Nicoletta de Matthaeis, Francesca Romana Ponziani, Andrea Olivani, Gabriele Missale, Valentina Cossiga, Mario Capasso, Filomena Morisco, Ester Marina Cela, Antonio Facciorusso, Valentina Lauria, Giorgia Ghittoni, Giorgio Pelecca, Fabrizio Chegai, Fabio Coratella, Mariano Ortenzi, Serena Dell'Isola, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Elton Dajti, Federico Ravaioli, Filippo Oliveri, Gabriele Ricco, Veronica Romagnoli, Alessandro Inno, Fabiana Marchetti, Pietro Coccoli, Antonio Malerba, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Giannini, Edoardo G, Pieri, Giulia, Labanca, Sara, Plaz Torres, Maria Corina, Gasbarrini, Antonio, Biasini, Elisabetta, Campani, Claudia, Cazzagon, Nora, Foschi, Francesco Giuseppe, Mega, Andrea, Masotto, Alberto, Raimondo, Giovanni, Rapaccini, Gian Ludovico, Sacco, Rodolfo, Caturelli, Eugenio, Guarino, Maria, Tovoli, Francesco, Vidili, Gianpaolo, Brunetto, Maurizia Rossana, Nardone, Gerardo, Svegliati-Baroni, Gianluca, Magalotti, Donatella, Azzaroli, Francesco, Cabibbo, Giuseppe, Di Marco, Maria, Sangiovanni, Angelo, Trevisani, Franco, Giannini, E. G., Pieri, G., Labanca, S., Plaz Torres, M. C., Gasbarrini, A., Biasini, E., Campani, C., Cazzagon, N., Foschi, F. G., Mega, A., Masotto, A., Raimondo, G., Rapaccini, G. L., Sacco, R., Caturelli, E., Guarino, M., Tovoli, F., Vidili, G., Brunetto, M. R., Nardone, G., Svegliati-Baroni, G., Magalotti, D., Azzaroli, F., Cabibbo, G., Di Marco, M., Sangiovanni, A., Trevisani, F., Biselli, M., Caraceni, P., Gramenzi, A., Benevento, F., Granito, A., Muratori, L., Piscaglia, F., Bertellini, F., Farinati, F., Palano, G., Pelizzaro, F., Penzo, B., Pinto, E., Allegrini, G., Camma, C., Celsa, C., Giuffrida, P., Stornello, C., Grova, M., Giacchetto, C. M., Rancatore, G., Grassini, M. V., Adotti, V., Gitto, S., Marra, F., Rosi, M., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Napoli, L., Domenicali, M., Migliano, M. T., de Matthaeis, N., Ponziani, F. R., Olivani, A., Missale, G., Cossiga, V., Capasso, M., Morisco, F., Cela, E. M., Facciorusso, A., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Dell'Isola, S., Franze, M. S., Saitta, C., Sauchella, A., Dajti, E., Ravaioli, F., Oliveri, F., Ricco, G., Romagnoli, V., Inno, A., Marchetti, F., Coccoli, P., Malerba, A., Cappelli, A., Golfieri, R., Mosconi, C., and Renzulli, M.

Subjects
Male, Carcinoma, Hepatocellular, Cholestatic liver disease, Outcome, Surveillance, Survival, Treatment, Hepatology, Prognosi, Liver Cirrhosis, Biliary, Risk Factor, Settore MED/12 - GASTROENTEROLOGIA, Liver Neoplasms, Gastroenterology, Prognosis, Risk Factors, Humans, Female, Human, Aged
Abstract

Background: Comprehensive and contemporary data pertaining large populations of patients with Primary Biliary Cholangitis (PBC) and hepatocellular carcinoma (HCC) are missing. Aim: To describe main characteristics and outcome of PBC patients with HCC diagnosed in the new millennium. Methods: Analysing the Italian Liver Cancer registry we identified 80 PBC patients with HCC diagnosed after the year 2000, and described their clinical characteristics, access to treatment and survival. Results: Median age of patients was 71 years and 50.0% were males. Cirrhosis was present in 86.3% of patients, being well-compensated in 58.0%. Median HCC diameter was smaller in patients under surveillance (2.6vs 4.0cm, P=0.007). Curative treatment, feasible in 50.0% of patients, was associated with improved survival compared to palliative and supportive care (42vs 33vs 6 months, P

Published
2022

27. Surveillance for hepatocellular carcinoma with a 3-months interval in 'extremely high-risk' patients does not further improve survival

Author

Filippo Pelizzaro, Giulia Peserico, Marco D'Elia, Nora Cazzagon, Francesco Paolo Russo, Alessandro Vitale, Edoardo G. Giannini, Manuela Piccinnu, Gian Ludovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Rodolfo Sacco, Giuseppe Cabibbo, Fabio Marra, Andrea Mega, Filomena Morisco, Antonio Gasbarrini, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Andrea Olivani, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Filippo Oliveri, Franco Trevisani, Fabio Farinati, Maurizio Biselli, Paolo Caraceni, Francesca Garuti, Annagiulia Gramenzi, Andrea Neri, Valentina Santi, Fabio Piscaglia, Francesco Tovoli, Alessandro Granito, Luca Muratori, Francesca Benevento, Elton Dajti, Giovanni Marasco, Federico Ravaioli, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Angela Imondi, Anna Sartori, Barbara Penzo, Elisa Pinto, Ester Marina Cela, Antonio Facciorusso, Valentina Cacciato, Edoardo Casagrande, Alessandro Moscatelli, Gaia Pellegatta, Nicoletta De Matthaeis, Gloria Allegrini, Valentina Lauria, Giorgia Ghittoni, Giorgio Pelecca, Fabrizio Chegai, Fabio Coratella, Mariano Ortenzi, Gabriele Missale, Alessandro Inno, Fabiana Marchetti, Anita Busacca, Calogero Cammà, Vincenzo Di Martino, Giacomo Emanuele Maria Rizzo, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Vittoria Bevilacqua, Alberto Borghi, Andrea Casadei Gardini, Fabio Conti, Anna Chiara Dall'aglio, Giorgio Ercolani, Federica Mirici, Claudia Campani, Chiara Di Bonaventura, Stefano Gitto, Pietro Coccoli, Antonio Malerba, Maria Guarino, Maurizia Brunetto, Veronica Romagnoli, Pelizzaro, F., Peserico, G., D'Elia, M., Cazzagon, N., Russo, F. P., Vitale, A., Giannini, E. G., Piccinnu, M., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Marra, F., Mega, A., Morisco, F., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Olivani, A., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Farinati, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Santi, V., Piscaglia, F., Tovoli, F., Granito, A., Muratori, L., Benevento, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Imondi, A., Sartori, A., Penzo, B., Pinto, E., Cela, E. M., Facciorusso, A., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., De Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Missale, G., Inno, A., Marchetti, F., Busacca, A., Camma, C., Di Martino, V., Rizzo, G. E. M., Franze, M. S., Saitta, C., Sauchella, A., Bevilacqua, V., Borghi, A., Casadei Gardini, A., Conti, F., Dall'Aglio, A. C., Ercolani, G., Mirici, F., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Guarino, M., Brunetto, M., Romagnoli, V., Pelizzaro, Filippo, Peserico, Giulia, D'Elia, Marco, Cazzagon, Nora, Russo, Francesco Paolo, Vitale, Alessandro, Giannini, Edoardo G., Piccinnu, Manuela, Rapaccini, Gian Ludovico, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Sacco, Rodolfo, Cabibbo, Giuseppe, Marra, Fabio, Mega, Andrea, Morisco, Filomena, Gasbarrini, Antonio, Svegliati-Baroni, Gianluca, Foschi, Francesco Giuseppe, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Raimondo, Giovanni, Azzaroli, Francesco, Vidili, Gianpaolo, Oliveri, Filippo, Trevisani, Franco, Farinati, Fabio, Biselli, Maurizio, Caraceni, Paolo, Garuti, Francesca, Gramenzi, Annagiulia, Neri, Andrea, Santi, Valentina, Piscaglia, Fabio, Tovoli, Francesco, Granito, Alessandro, Muratori, Luca, Benevento, Francesca, Dajti, Elton, Marasco, Giovanni, Ravaioli, Federico, Cappelli, Alberta, Golfieri, Rita, Mosconi, Cristina, Renzulli, Matteo, Imondi, Angela, Sartori, Anna, Penzo, Barbara, Pinto, Elisa, Cela, Ester Marina, Facciorusso, Antonio, Cacciato, Valentina, Casagrande, Edoardo, Moscatelli, Alessandro, Pellegatta, Gaia, De Matthaeis, Nicoletta, Allegrini, Gloria, Lauria, Valentina, Ghittoni, Giorgia, Pelecca, Giorgio, Chegai, Fabrizio, Coratella, Fabio, Ortenzi, Mariano, Missale, Gabriele, Inno, Alessandro, Marchetti, Fabiana, Busacca, Anita, Cammà, Calogero, Di Martino, Vincenzo, Rizzo, Giacomo Emanuele Maria, Franzè, Maria Stella, Saitta, Carlo, Sauchella, Assunta, Bevilacqua, Vittoria, Borghi, Alberto, Casadei Gardini, Andrea, Conti, Fabio, Dall'aglio, Anna Chiara, Ercolani, Giorgio, Mirici, Federica, Campani, Claudia, Di Bonaventura, Chiara, Gitto, Stefano, Coccoli, Pietro, Malerba, Antonio, Guarino, Maria, Brunetto, Maurizia, and Romagnoli, Veronica

Subjects
medicine.medical_specialty, Carcinoma, Hepatocellular, Survival, Hepatocellular carcinoma, Cancer stage, Surveillance interval, Internal medicine, medicine, Humans, Propensity Score, Survival analysis, High risk patients, Hepatology, business.industry, Liver Neoplasms, Settore MED/09 - MEDICINA INTERNA, Gastroenterology, Patient survival, medicine.disease, Survival Analysis, Propensity score matching, Survival Analysi, Liver cancer, business, Median survival, Human
Abstract

Background An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC). Aims We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival. Methods Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching. Results The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9–64.0]) was not significantly different from the observed (47.0 months [35.0–58.9]; p = 0.43) and adjusted (44.9 months [33.4–56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients. Conclusions A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.

Published
2022

28. Probiotics in Gastrointestinal Diseases: All that Glitters Is Not Gold

Author

Debora Compare, C. Sgamato, Pietro Coccoli, Olga Maria Nardone, Carmen Laurenza, Gerardo Nardone, Alba Rocco, Compare, D., Sgamato, C., Nardone, O. M., Rocco, A., Coccoli, P., Laurenza, C., and Nardone, G.

Subjects
medicine.medical_specialty, Helicobacter pylori infection, Gastrointestinal Diseases, Gastrointestinal Disease, Gut microbiota, Gut flora, Inflammatory bowel disease, Helicobacter Infections, law.invention, Irritable Bowel Syndrome, Probiotic, law, Flora (microbiology), medicine, Humans, Risks and benefits, Intensive care medicine, Irritable bowel syndrome, biology, Helicobacter pylori, business.industry, Probiotics, Gastroenterology, General Medicine, medicine.disease, biology.organism_classification, Healthcare settings, business, Helicobacter Infection, Human
Abstract

Background: Multiple lines of evidence now support the notion that gut microbiota can contribute to digestive and extra-digestive diseases. The emergence of these observations enabled to postulate a bacteria-centric paradigm to rethink the treatment of many diseases. The goal of therapy should not be to eradicate the flora but to modify it in a way that leads to symptomatic improvement; thus, the interest in the use of probiotics to modulate microbiota composition has increased worldwide in both community and healthcare settings. Summary: The results of published studies are conflicting for most probiotic strains and formulations, and clinicians and consumers need a better understanding of probiotic risks and benefits. Currently, clear guidelines on when to use probiotics and the most effective probiotic for different gastrointestinal conditions are still lacking. Here, we reviewed the studies on the use of probiotics in some diseases of relevant interest to gastroenterologists, such as Helicobacter pylori infection, irritable bowel syndrome, and inflammatory bowel disease. Key Message: Although the evidence is relevant and promising for probiotics in general, and for specific strains and combinations of strains, it is not yet sufficient to draw unequivocal conclusions and clear recommendations.

Published
2022

29. Prognostic performance of the 'DICA' endoscopic classification and the 'CODA' score in predicting clinical outcomes of diverticular disease: an international, multicentre, prospective cohort study

Author

Antonio, Tursi, Giovanni, Brandimarte, Francesco, Di Mario, Walter, Elisei, Marcello, Picchio, Leonardo, Allegretta, Maria Laura, Annunziata, Mauro, Bafutto, Gabrio, Bassotti, Maria Antonietta, Bianco, Raffaele, Colucci, Rita, Conigliaro, Dan, Dumitrascu, Ricardo, Escalante, Luciano, Ferrini, Giacomo, Forti, Marilisa, Franceschi, Maria Giovanna, Graziani, Frank, Lammert, Giovanni, Latella, Giovanni, Maconi, Gerardo, Nardone, Lucia, Camara de Castro Oliveira, Enio, Chaves Oliveira, Alfredo, Papa, Savvas, Papagrigoriadis, Anna, Pietrzak, Stefano, Pontone, Tomas, Poskus, Giuseppe, Pranzo, Matthias Christian, Reichert, Stefano, Rodinò, Jaroslaw, Regula, Giuseppe, Scaccianoce, Franco, Scaldaferri, Roberto, Vassallo, Costantino, Zampaletta, Angelo, Zullo, Daniele, Piovani, Stefanos, Bonovas, Silvio, Danese, Paolo, Usai, Tursi, A., Brandimarte, G., Di Mario, F., Elisei, W., Picchio, M., Allegretta, L., Annunziata, M. L., Bafutto, M., Bassotti, G., Bianco, M. A., Colucci, R., Conigliaro, R., Dumitrascu, D., Escalante, R., Ferrini, L., Forti, G., Franceschi, M., Graziani, M. G., Lammert, F., Latella, G., Maconi, G., Nardone, G., Camara de Castro Oliveira, L., Chaves Oliveira, E., Papa, A., Papagrigoriadis, S., Pietrzak, A., Pontone, S., Poskus, T., Pranzo, G., Reichert, M. C., Rodino, S., Regula, J., Scaccianoce, G., Scaldaferri, F., Vassallo, R., Zampaletta, C., Zullo, A., Piovani, D., Bonovas, S., and Danese, S.

Subjects
medicine.medical_specialty, Prognosi, diverticular disease, Coda, Cohort Studies, Colonic, Internal medicine, Diverticulosis, Colonic, medicine, Humans, Prospective Studies, endoscopy, Prospective cohort study, Diverticuliti, Diverticulitis, Inflammation, Diverticular Diseases, Diverticulosis, medicine.diagnostic_test, business.industry, Colonoscopy, Prognosis, Diverticulum, Gastroenterology, medicine.disease, Endoscopy, Prospective Studie, Diverticular disease, Cohort Studie, business, Complication, Human, Cohort study
Abstract

ObjectiveTo investigate the predictive value of the Diverticular Inflammation and Complication Assessment (DICA) classification and to develop and validate a combined endoscopic-clinical score predicting clinical outcomes of diverticulosis, named Combined Overview on Diverticular Assessment (CODA).DesignA multicentre, prospective, international cohort study.Setting43 gastroenterology and endoscopy centres located in Europe and South America.Participants2215 patients (2198 completing the study) at the first diagnosis of diverticulosis/diverticular disease were enrolled. Patients were scored according to DICA classifications.InterventionsA 3-year follow-up was performed.Main outcome measuresTo predict the acute diverticulitis and the surgery according to DICA classification. Survival methods for censored observation were used to develop and validate a novel combined endoscopic-clinical score for predicting diverticulitis and surgery (CODA score).ResultsThe 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p10% and >2.5% in CODA C, respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (c-statistic: 0.829; 95% CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981).ConclusionsDICA classification has a significant role in predicting the risk of diverticulitis and surgery in patients with diverticulosis, which is significantly enhanced by the CODA score.Trial registration numberNCT02758860.

Published
2022

30. Epidemiological trends and trajectories of MAFLD-associated hepatocellular carcinoma 2002-2033: The ITA.LI.CA database

Author

Alessandro, Vitale, Gianluca, Svegliati-Baroni, Alessio, Ortolani, Monica, Cucco, Giulio V, Dalla Riva, Edoardo G, Giannini, Fabio, Piscaglia, Gianludovico, Rapaccini, Mariella, Di Marco, Eugenio, Caturelli, Marco, Zoli, Rodolfo, Sacco, Giuseppe, Cabibbo, Fabio, Marra, Andrea, Mega, Filomena, Morisco, Antonio, Gasbarrini, Francesco Giuseppe, Foschi, Gabriele, Missale, Alberto, Masotto, Gerardo, Nardone, Giovanni, Raimondo, Francesco, Azzaroli, Gianpaolo, Vidili, Filippo, Oliveri, Filippo, Pelizzaro, Rafael, Ramirez Morales, Umberto, Cillo, Franco, Trevisani, Luca, Miele, Giulio, Marchesini, Fabio, Farinati, Alessandro, Di Bucchianico, Vitale, A., Svegliati-Baroni, G., Ortolani, A., Cucco, M., Dalla Riva, G. V., Giannini, E. G., Piscaglia, F., Rapaccini, G., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Marra, F., Mega, A., Morisco, F., Gasbarrini, A., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Pelizzaro, F., Ramirez Morales, R., Cillo, U., Trevisani, F., Miele, L., Marchesini, G., Farinati, F., Alessandro Vitale, Gianluca Svegliati-Baroni, Alessio Ortolani, Monica Cucco, Giulio V Dalla Riva, Edoardo G Giannini, Fabio Piscaglia, Gianludovico Rapaccini, Mariella Di Marco, Eugenio Caturelli, Marco Zoli, Rodolfo Sacco, Giuseppe Cabibbo, Fabio Marra, Andrea Mega, Filomena Morisco, Antonio Gasbarrini, Francesco Giuseppe Foschi, Gabriele Missale, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Filippo Oliveri, Filippo Pelizzaro, Rafael Ramirez Morales, Umberto Cillo, Franco Trevisani, Luca Miele, Giulio Marchesini, Fabio Farinati, Vitale, Alessandro, Svegliati-Baroni, Gianluca, Ortolani, Alessio, Cucco, Monica, Dalla Riva, Giulio V, Giannini, Edoardo G, Piscaglia, Fabio, Rapaccini, Gianludovico, Di Marco, Mariella, Caturelli, Eugenio, Zoli, Marco, Sacco, Rodolfo, Cabibbo, Giuseppe, Marra, Fabio, Mega, Andrea, Morisco, Filomena, Gasbarrini, Antonio, Foschi, Francesco Giuseppe, Missale, Gabriele, Masotto, Alberto, Nardone, Gerardo, Raimondo, Giovanni, Azzaroli, Francesco, Vidili, Gianpaolo, Oliveri, Filippo, Pelizzaro, Filippo, Ramirez Morales, Rafael, Cillo, Umberto, Trevisani, Franco, Miele, Luca, Marchesini, Giulio, and Farinati, Fabio

Subjects
Male, Settore MED/12 - Gastroenterologia, Carcinoma, Hepatocellular, Liver Neoplasms, nonalcoholic steatohepatitis, Gastroenterology, hepatocellular carcinoma, digestive system diseases, Non-alcoholic Fatty Liver Disease, Risk Factors, Humans, neoplasms
Abstract

BackgroundMetabolic dysfunction-associated fatty liver disease (MAFLD) represents a new inclusive definition of the whole spectrum of liver diseases associated to metabolic disorders. The main objective of this study was to compare patients with MAFLD and non-MAFLD with hepatocellular carcinoma (HCC) included in a nationally representative cohort.MethodsWe analysed 6882 consecutive patients with HCC enrolled from 2002 to 2019 by 23 Italian Liver Cancer centres to compare epidemiological and future trends in three subgroups: pure, single aetiology MAFLD (S-MAFLD); mixed aetiology MAFLD (metabolic and others, M-MAFLD); and non-MAFLD HCC.ResultsMAFLD was diagnosed in the majority of patients with HCC (68.4%). The proportion of both total MAFLD and S-MAFLD HCC significantly increased over time (from 50.4% and 3.6% in 2002–2003, to 77.3% and 28.9% in 2018–2019, respectively, pConclusionsThe prevalence of MAFLD HCC in Italy is rapidly increasing to cover the majority of patients with HCC. Despite a less favourable cancer stage at diagnosis, patients with MAFLD HCC have a lower risk of HCC-related death, suggesting reduced cancer aggressiveness.

Published
2021

31. Type 2 diabetes combined with portal vein tumor thrombosis worsens prognosis in patients with hepatocellular carcinoma

Author

Debora Angrisani, Marco Guarracino, Nunzia Farella, Filomena Morisco, Carmine Coppola, Francesco Izzo, Angelo Salomone Megna, Alessandro Federico, Vincenzo Messina, Gerardo Nardone, Guido Piai, Enrico Ragone, Luigi Elio Adinolfi, Giuseppe D’Adamo, Maria Stanzione, Giampiero Francica, Marcello Persico, Vincenzo De Girolamo, Coppola Nicola, Lucia Rocco, Giovan Giuseppe Di Costanzo, and Raffaella Tortora

Subjects
Hepatology
Published
2022

33. Autoimmune hepatitis following SARS-CoV-2 vaccine: May not be a casuality

Author

Debora Compare, Alba Rocco, Gerardo Nardone, C. Sgamato, Rocco, A., Sgamato, C., Compare, D., and Nardone, G.

Subjects
Covid-19 vaccine, 2019-20 coronavirus outbreak, Hepatology, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, SARS-CoV-2 infection, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, Autoimmune hepatitis, medicine.disease, Autoimmune Hepatiti, Virology, Hepatitis, Autoimmune, medicine, Autoimmune Hepatitis, business, Letter to the Editor, Human
Published
2021

34. The Combination of Shear Wave Elastography and Elf Test in a Single Score Improves the Diagnostic Specificity for Liver Fibrosis Prediction

Author

Raffaele Liuzzi, Monica Ragucci, Peppino Mirabelli, Angelo Megna, Massimo De Luca, Giuseppina Marino Marsilia, Gerardo Nardone, Pietro Coccoli, Emilia Vergara, Mariarosaria Incoronato, Marco Salvatore, and Marcello Mancini

Abstract

Background. Chronic liver diseases (CHDs) are an important public health issue. The presence of significant fibrosis is a hallmark for liver disease staging and prognosis. Aims. To develop a non-invasive score that can discriminate between patients with or without fibrosis in the aim to avoid liver biopsy.Methods. Forty patients with CHDs who received liver biopsy to stage fibrosis and 12 normal subjects performed also share wave elastography (SWE) and ELF-test. We chose two different outcome for histological fibrosis (F0-F1 vs F2-F4) and (F0-F2 vs F3-F4). ELF-test and SWE were independent predictors, categorized using ROC analysis. Two scores called SCORE1 and SCORE2 were devised.Results. The discriminatory values for SCORE1 were SWE>5.62 kPa and ELF-test >9.33 and for SCORE2 were SWE>7.04 kPa and ELF-test 9.33. SCORE1 specificity was 91.7% (CI 77.5-98.2%), significatively greater than obtained using SWE 63.9% (CI 46.2-79.2%; p=0.0013) or ELF-test 83.3% (CI 67.2-93.6%; p=0.1760) separately. SCORE2 specificity was 95.2% (CI 83.8-99.4%). This value was not-significatively greater than obtained using SWE or ELF-test 81.0% (CI 65.9-91.4%; p=0.0921) separately. Conclusion. SWE and ELF-test can be performed for non-invasive staging of liver fibrosis. Their use grouped in a single score increase the specificity for the prediction of histological fibrosis stage.

Published
2021

35. Bone Marrow of Contention: A Rare Case of Recurrent Acute Hepatitis

Author

Bruno Amato, Antonio M. Risitano, Debora Compare, C. Sgamato, Gerardo Nardone, Alba Rocco, Rocco, A., Compare, D., Risitano, A. M., Sgamato, C., Amato, B., and Nardone, G.

Subjects
Male, medicine.medical_specialty, Physiology, Hemoglobinuria, Paroxysmal, Jaundice, Gastroenterology, Hypertransaminasemia, Hepatitis, Young Adult, Complement inhibitor, Bone Marrow, hemic and lymphatic diseases, Internal medicine, medicine, Humans, Aplastic anemia, Paroxysmal nocturnal hemoglobinuria, business.industry, Anemia, Aplastic, Hepatology, Eculizumab, medicine.disease, medicine.anatomical_structure, Bone marrow, medicine.symptom, business, medicine.drug, Acute hepatiti
Abstract

Hepatitis-associated aplastic anemia is a well-recognized clinical syndrome in which marrow failure follows the development of hepatitis. Although aplastic anemia is intimately related to paroxysmal nocturnal hemoglobinuria, until now, no cases of PNH-associated hepatitis have been described. We report a case of recurrent acute hepatitis preceding the clinical onset of PNH. Treatment of PNH with the complement inhibitor eculizumab (Soliris®) prevented both recurrences of episodes of intravascular hemolysis and liver enzyme alteration. This is the first known published case of PNH-associated hepatitis.

Published
2021

36. Changes in hepatocellular carcinoma aggressiveness characteristics with an increase in tumor diameter

Author

Giovanni Raimondo, Alberto Masotto, Edoardo G. Giannini, Filippo Oliveri, Fabio Piscaglia, Francesco Giuseppe Foschi, Giuseppe Cabibbo, Gianpaolo Vidili, Francesco Azzaroli, Gian Ludovico Rapaccini, Antonio Gasbarrini, Rodolfo Sacco, Franco Trevisani, Gerardo Nardone, Maria Di Marco, Fabio Marra, Brian I. Carr, Eugenio Caturelli, Andrea Mega, Marco Zoli, Filomena Morisco, Vito Guerra, Gianluca Svegliati-Baroni, Fabio Farinati, Gabriele Missale, Rossella Donghia, Carr B.I., Guerra V., Donghia R., Farinati F., Giannini E.G., Piscaglia F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Sacco R., Cabibbo G., Marra F., Mega A., Morisco F., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Missale G., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Oliveri F., Trevisani F., Carr, B. I., Guerra, V., Donghia, R., Farinati, F., Giannini, E. G., Piscaglia, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Marra, F., Mega, A., Morisco, F., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., and Trevisani, F.

Subjects
Male, Cancer Research, Pathology, medicine.medical_specialty, Carcinoma, Hepatocellular, Prognosi, Settore MED/12 - GASTROENTEROLOGIA, Clinical Biochemistry, size, Pathology and Forensic Medicine, evolution, medicine, Humans, Prospective Studies, HCC, Tumor size, business.industry, Liver Neoplasms, Carcinoma, Settore MED/09 - MEDICINA INTERNA, Hepatocellular, Middle Aged, Prognosis, medicine.disease, Portal vein thrombosis, trend, Oncology, Liver Neoplasm, Hepatocellular carcinoma, Female, business, Human
Abstract

Background: Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation. Aims: To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases. Methods: A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality. Results: A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels ( PConclusions: The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.

Published
2021

37. Effectiveness and predictors of response to somatostatin analogues in patients with gastrointestinal angiodysplasias: a systematic review and individual patient data meta-analysis

Author

Raul Prados-Manzano, Grainne Holleran, Spyridon Michopoulos, Stefania Chetcuti Zammit, Santiago Frago, Erwin J M van Geenen, Deirdre McNamara, Joost P.H. Drenth, Karina V. Grooteman, Lia C. M. J. Goltstein, Gerardo Nardone, Mourad Benallaoua, Giuseppe Scaglione, Robert Benamouzig, Paulo S Salgueiro, Thomas Aparicio, Reena Sidhu, Wietske Kievit, Alba Rocco, Goltstein, L. C. M. J., Grooteman, K. V., Rocco, A., Holleran, G., Frago, S., Salgueiro, P. S., Aparicio, T., Scaglione, G., Chetcuti Zammit, S., Prados-Manzano, R., Benamouzig, R., Nardone, G., Mcnamara, D., Benallaoua, M., Michopoulos, S., Sidhu, R., Kievit, W., Drenth, J. P. H., and van Geenen, E. J. M.

Subjects
medicine.medical_specialty, Gastrointestinal Diseases, MEDLINE, Octreotide, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], Lanreotide, Peptides, Cyclic, law.invention, Angiodysplasia, chemistry.chemical_compound, Randomized controlled trial, Gastrointestinal Agents, law, Internal medicine, medicine, Humans, Hepatology, business.industry, Gastroenterology, Patient data, Somatostatin, Treatment Outcome, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], chemistry, Meta-analysis, Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5], business, Erythrocyte Transfusion, Gastrointestinal Hemorrhage, medicine.drug, Cohort study
Abstract

Item does not contain fulltext BACKGROUND: Gastrointestinal angiodysplasias are vascular malformations that often cause red blood cell transfusion-dependent anaemia. Several studies suggest that somatostatin analogues might decrease rebleeding rates, but the true effect size is unknown. We therefore aimed to investigate the efficacy of somatostatin analogues on red blood cell transfusion requirements of patients with gastrointestinal angiodysplasias and to identify subgroups that might benefit the most from somatostatin analogue therapy. METHODS: We did a systematic review and individual patient data meta-analysis. We searched MEDLINE, Embase, and Cochrane on Jan 15, 2016, with an updated search on April 25, 2021. All published randomised controlled trials and cohort studies that reported on somatostatin analogue therapy in patients with gastrointestinal angiodysplasias were eligible for screening. We excluded studies without original patient data, single case reports, small case series (ie

Published
2021

38. Identification of clinical phenotypes and related survival in patients with large hccs

Author

Rossella Donghia, Antonio Gasbarrini, Giovanni Raimondo, Elisabetta Biasini, Francesco Giuseppe Foschi, Gianpaolo Vidili, Maria Guarino, Andrea Mega, Marco Zoli, Rodolfo Sacco, Fabio Farinati, Brian I. Carr, Gianluca Svegliati-Baroni, Ciro Celsa, Eugenio Caturelli, Edoardo G. Giannini, Vito Guerra, Gian Ludovico Rapaccini, Maria Di Marco, Gerardo Nardone, Franco Trevisani, Claudia Campani, Luca Muratori, Francesco Azzaroli, Maurizia Rossana Brunetto, Alberto Masotto, Carr B.I., Guerra V., Donghia R., Farinati F., Giannini E.G., Muratori L., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Sacco R., Celsa C., Campani C., Mega A., Guarino M., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Biasini E., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Brunetto M.R., Trevisani F., Carr, B. I., Guerra, V., Donghia, R., Farinati, F., Giannini, E. G., Muratori, L., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Celsa, C., Campani, C., Mega, A., Guarino, M., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Biasini, E., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Brunetto, M. R., and Trevisani, F.

Subjects
0301 basic medicine, Cancer Research, medicine.medical_specialty, PVT, Settore MED/12 - GASTROENTEROLOGIA, Serum albumin, lcsh:RC254-282, Gastroenterology, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Platelet, HCC, neoplasms, Survival rate, biology, business.industry, Proportional hazards model, Albumin, Hazard ratio, Settore MED/09 - MEDICINA INTERNA, Multifocality, large, phenotypes, multifocality, albumin, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, digestive system diseases, Portal vein thrombosis, Large, Phenotypes, Phenotype, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, biology.protein, business
Abstract

Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin &gt, 3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (&lt, 100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. Conclusions. Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.

Published
2021

39. Clinical features and comorbidity pattern of HCV infected migrants compared to native patients in care in Italy: A real-life evaluation of the PITER cohort

Author

Maria Giovanna Quaranta, Luigina Ferrigno, Xhimi Tata, Franca D'Angelo, Marco Massari, Carmine Coppola, Elisa Biliotti, Alessia Giorgini, Diletta Laccabue, Alessia Ciancio, Pier Luigi Blanc, Marzia Margotti, Donatella Ieluzzi, Maurizia Rossana Brunetto, Francesco Barbaro, Francesco Paolo Russo, Ilaria Beretta, Giulia Morsica, Gabriella Verucchi, Annalisa Saracino, Massimo Galli, Loeta A. Kondili, Cesare Mazzaro, Manuela Bertola, Ornella Schioppa, Antonio Benedetti, Laura Schiadà, Monica Cucco, Andrea Giacometti, Laura Brescini, Sefora Castelletti, Alessandro Fiorentini, Gioacchino Angarano, Michele Milella, Alfredo Di Leo, Maria Rendina, Fulvio Salvatore D'abramo, Chiara Lillo, Andrea Iannone, Mariano Piazzolla, Lorenzo Badia, Fabio Piscaglia, Francesca Benevento, Ilaria Serio, Francesco Castelli, Serena Zaltron, Angiola Spinetti, Silvia Odolini, Raffaele Bruno, Mario Mondelli, Luchino Chessa, Martina Loi, Carlo Torti, Chiara Costa, Maria Mazzitelli, Vincenzo Pisani, Vincenzo Scaglione, Enrico Maria Trecarichi, Anna Linda Zignego, Monica Monti, Francesco Madia, Letizia Attala, Piera Pierotti, Elena Salomoni, Elisa Mariabelli, Teresa Antonia Santantonio, Serena Rita Bruno, Ester Marina Cela, Matteo Bassetti, Giovanni Mazzarello, Anna Ida Alessandrini, Antonio Di Biagio, Laura Ambra Nicolini, Giovanni Raimondo, Roberto Filomia, Alessio Aghemo, Rossella Meli, Adriano Lazzarin, Stefania Salpietro, Anna Ludovica Fracanzani, Erika Fatta, Rosa Lombardi, Pietro Lampertico, Marta Borghi, Roberta D'ambrosio, Elisabetta Degasperi, Massimo Puoti, Chiara Baiguera, Federico D'amico, Maria Vinci, Maria Grazia Rumi, Massimo Zuin, Paola Zermiani, Pietro Andreone, Paolo Caraceni, Valeria Guarneri, Erica Villa, Veronica Bernabucci, Laura Bristot, Maria Luisa Paradiso, Guglielmo Migliorino, Alessandra Gambaro, Giuseppe Lapadula, Anna Spolti, Alessandro Soria, Pietro Invernizzi, Antonio Ciaccio, Martina LucÀ, Federica Malinverno, Laura Ratti, Daniela Caterina Amoruso, Federica Pisano, Ferdinando Scarano, Laura Staiano, Filomena Morisco, Valentina Cossiga, Ivan Gentile, Antonio Riccardo Buonomo, Maria Foggia, Emanuela Zappulo, Alessandro Federico, Marcello Dallio, Nicola Coppola, Caterina Sagnelli, Salvatore Martini, Caterina Monari, Gerardo Nardone, Costantino Sgamato, Liliana Chemello, Luisa Cavalletto, Daniela Sterrantino, Alberto Zanetto, Paola Zanaga, Giuseppina Brancaccio, Antonio Craxì, Salvatore Petta, Vincenza Calvaruso, Luciano Crapanzano, Salvatore Madonia, Marco Cannizzaro, Erica Maria Bruno, Anna Licata, Simona Amodeo, Adele Rosaria Capitano, Carlo Ferrari, Elisa Negri, Alessandra Orlandini, Marco Pesci, Roberto Gulminetti, Layla Pagnucco, Giustino Parruti, Paola Di Stefano, Barbara Coco, Romina Corsini, Elisa Garlassi, Massimo Andreoni, Elisabetta Teti, Carlotta Cerva, Lorenzo Baiocchi, Giuseppe Grassi, Antonio Gasbarrini, Maurizio Pompili, Martina De Siena, Gloria Taliani, Martina Spaziante, Marcello Persico, Mario Masarone, Andrea Aglitti, Gemma Calvanese, Marco Anselmo, Pasqualina De Leo, Monica Marturano, Giorgio Maria Saracco, Quaranta M.G., Ferrigno L., Tata X., D'Angelo F., Massari M., Coppola C., Biliotti E., Giorgini A., Laccabue D., Ciancio A., Blanc P.L., Margotti M., Ieluzzi D., Brunetto M.R., Barbaro F., Russo F.P., Beretta I., Morsica G., Verucchi G., Saracino A., Galli M., Kondili L.A., Mazzaro C., Bertola M., Benedetti A., Schiada L., Cucco M., Giacometti A., Brescini L., Castelletti S., Fiorentini A., Angarano G., Milella M., Leo A.D., Rendina M., Salvatore D'ABRAMO F., Lillo C., Iannone A., Piazzolla M., Badia L., Piscaglia F., Benevento F., Serio I., Castelli F., Zaltron S., Spinetti A., Odolini S., Bruno R., Mondelli M., Chessa L., Loi M., Torti C., Costa C., Mazzitelli M., Pisani V., Scaglione V., Trecarichi E.M., Zignego A.L., Monti M., Madia F., Attala L., Pierotti P., Salomoni E., Mariabelli E., Santantonio T.A., Bruno S.R., Cela E.M., Bassetti M., Mazzarello G., Alessandrini A.I., Biagio A.D., Nicolini L.A., Raimondo G., Filomia R., Aghemo A., Meli R., Lazzarin A., Salpietro S., Fracanzani A.L., Fatta E., Lombardi R., Lampertico P., Borghi M., D'ambrosio R., Degasperi E., Puoti M., Baiguera C., D'AMICO F., Vinci M., Rumi M.G., Zuin M., Zermiani P., Andreone P., Caraceni P., Guarneri V., Villa E., Bernabucci V., Bristot L., Paradiso M.L., Migliorino G., Gambaro A., Lapadula G., Spolti A., Soria A., Invernizzi P., Ciaccio A., LucA M., Malinverno F., Ratti L., Amoruso D.C., Pisano F., Scarano F., Staiano L., Morisco F., Cossiga V., Gentile I., Buonomo A.R., Foggia M., Zappulo E., Federico A., Dallio M., Coppola N., Sagnelli C., Martini S., Monari C., Nardone G., Sgamato C., Chemello L., Cavalletto L., Sterrantino D., Zanetto A., Zanaga P., Brancaccio G., Craxi A., Petta S., Calvaruso V., Crapanzano L., Madonia S., Cannizzaro M., Bruno E.M., Licata A., Amodeo S., Capitano A.R., Ferrari C., Negri E., Orlandini A., Pesci M., Gulminetti R., Pagnucco L., Parruti G., Stefano P.D., Coco B., Corsini R., Garlassi E., Andreoni M., Teti E., Cerva C., Baiocchi L., Grassi G., Gasbarrini A., Pompili M., Siena M.D., Taliani G., Spaziante M., Persico M., Masarone M., Aglitti A., Calvanese G., Anselmo M., Leo P.D., Marturano M., Saracco G.M., Quaranta, M, Ferrigno, L, Tata, X, D'Angelo, F, Massari, M, Coppola, C, Biliotti, E, Giorgini, A, Laccabue, D, Ciancio, A, Blanc, P, Margotti, M, Ieluzzi, D, Brunetto, M, Barbaro, F, Russo, F, Beretta, I, Morsica, G, Verucchi, G, Saracino, A, Galli, M, Kondili, L, Mazzaro, C, Bertola, M, Benedetti, A, Schiada, L, Cucco, M, Giacometti, A, Brescini, L, Castelletti, S, Fiorentini, A, Angarano, G, Milella, M, Leo, A, Rendina, M, Salvatore D'ABRAMO, F, Lillo, C, Iannone, A, Piazzolla, M, Badia, L, Piscaglia, F, Benevento, F, Serio, I, Castelli, F, Zaltron, S, Spinetti, A, Odolini, S, Bruno, R, Mondelli, M, Chessa, L, Loi, M, Torti, C, Costa, C, Mazzitelli, M, Pisani, V, Scaglione, V, Trecarichi, E, Zignego, A, Monti, M, Madia, F, Attala, L, Pierotti, P, Salomoni, E, Mariabelli, E, Santantonio, T, Bruno, S, Cela, E, Bassetti, M, Mazzarello, G, Alessandrini, A, Biagio, A, Nicolini, L, Raimondo, G, Filomia, R, Aghemo, A, Meli, R, Lazzarin, A, Salpietro, S, Fracanzani, A, Fatta, E, Lombardi, R, Lampertico, P, Borghi, M, D'Ambrosio, R, Degasperi, E, Puoti, M, Baiguera, C, D'Amico, F, Vinci, M, Rumi, M, Zuin, M, Zermiani, P, Andreone, P, Caraceni, P, Guarneri, V, Villa, E, Bernabucci, V, Bristot, L, Paradiso, M, Migliorino, G, Gambaro, A, Lapadula, G, Spolti, A, Soria, A, Invernizzi, P, Ciaccio, A, Luca, M, Malinverno, F, Ratti, L, Amoruso, D, Pisano, F, Scarano, F, Staiano, L, Morisco, F, Cossiga, V, Gentile, I, Buonomo, A, Foggia, M, Zappulo, E, Federico, A, Dallio, M, Coppola, N, Sagnelli, C, Martini, S, Monari, C, Nardone, G, Sgamato, C, Chemello, L, Cavalletto, L, Sterrantino, D, Zanetto, A, Zanaga, P, Brancaccio, G, Craxi, A, Petta, S, Calvaruso, V, Crapanzano, L, Madonia, S, Cannizzaro, M, Bruno, E, Licata, A, Amodeo, S, Capitano, A, Ferrari, C, Negri, E, Orlandini, A, Pesci, M, Gulminetti, R, Pagnucco, L, Parruti, G, Stefano, P, Coco, B, Corsini, R, Garlassi, E, Andreoni, M, Teti, E, Cerva, C, Baiocchi, L, Grassi, G, Gasbarrini, A, Pompili, M, Siena, M, Taliani, G, Spaziante, M, Persico, M, Masarone, M, Aglitti, A, Calvanese, G, Anselmo, M, Leo, P, Marturano, M, Saracco, G, Quaranta, M. G., Ferrigno, L., Tata, X., D'Angelo, F., Massari, M., Coppola, C., Biliotti, E., Giorgini, A., Laccabue, D., Ciancio, A., Blanc, P. L., Margotti, M., Ieluzzi, D., Brunetto, M. R., Barbaro, F., Russo, F. P., Beretta, I., Morsica, G., Verucchi, G., Saracino, A., Galli, M., Kondili, L. A., Mazzaro, C., Bertola, M., Benedetti, A., Schiada, L., Cucco, M., Giacometti, A., Brescini, L., Castelletti, S., Fiorentini, A., Angarano, G., Milella, M., Leo, A. D., Rendina, M., Salvatore D'ABRAMO, F., Lillo, C., Iannone, A., Piazzolla, M., Badia, L., Piscaglia, F., Benevento, F., Serio, I., Castelli, F., Zaltron, S., Spinetti, A., Odolini, S., Bruno, R., Mondelli, M., Chessa, L., Loi, M., Torti, C., Costa, C., Mazzitelli, M., Pisani, V., Scaglione, V., Trecarichi, E. M., Zignego, A. L., Monti, M., Madia, F., Attala, L., Pierotti, P., Salomoni, E., Mariabelli, E., Santantonio, T. A., Bruno, S. R., Cela, E. M., Bassetti, M., Mazzarello, G., Alessandrini, A. I., Biagio, A. D., Nicolini, L. A., Raimondo, G., Filomia, R., Aghemo, A., Meli, R., Lazzarin, A., Salpietro, S., Fracanzani, A. L., Fatta, E., Lombardi, R., Lampertico, P., Borghi, M., D'Ambrosio, R., Degasperi, E., Puoti, M., Baiguera, C., D'Amico, F., Vinci, M., Rumi, M. G., Zuin, M., Zermiani, P., Andreone, P., Caraceni, P., Guarneri, V., Villa, E., Bernabucci, V., Bristot, L., Paradiso, M. L., Migliorino, G., Gambaro, A., Lapadula, G., Spolti, A., Soria, A., Invernizzi, P., Ciaccio, A., Luca, M., Malinverno, F., Ratti, L., Amoruso, D. C., Pisano, F., Scarano, F., Staiano, L., Morisco, F., Cossiga, V., Gentile, I., Buonomo, A. R., Foggia, M., Zappulo, E., Federico, A., Dallio, M., Coppola, N., Sagnelli, C., Martini, S., Monari, C., Nardone, G., Sgamato, C., Chemello, L., Cavalletto, L., Sterrantino, D., Zanetto, A., Zanaga, P., Brancaccio, G., Craxi, A., Petta, S., Calvaruso, V., Crapanzano, L., Madonia, S., Cannizzaro, M., Bruno, E. M., Licata, A., Amodeo, S., Capitano, A. R., Ferrari, C., Negri, E., Orlandini, A., Pesci, M., Gulminetti, R., Pagnucco, L., Parruti, G., Stefano, P. D., Coco, B., Corsini, R., Garlassi, E., Andreoni, M., Teti, E., Cerva, C., Baiocchi, L., Grassi, G., Gasbarrini, A., Pompili, M., Siena, M. D., Taliani, G., Spaziante, M., Persico, M., Masarone, M., Aglitti, A., Calvanese, G., Anselmo, M., Leo, P. D., Marturano, M., and Saracco, G. M.

Subjects
Male, HCV genotypes, Ethnic group, Linked-to-care patient, Comorbidity, Hepacivirus, Logistic regression, medicine.disease_cause, Comorbidities, Direct acting antivirals, HCV Cohort, Linked-to-care patients, Aged, Antiviral Agents, Coinfection, Female, Hepatitis C, Chronic, Humans, Italy, Middle Aged, Transients and Migrants, 0302 clinical medicine, Medicine, Chronic, Gastroenterology, virus diseases, Hepatitis C, Life evaluation, 030220 oncology & carcinogenesis, Cohort, 030211 gastroenterology & hepatology, Comorbiditie, Human, Hepatitis C virus, Settore MED/12 - GASTROENTEROLOGIA, 03 medical and health sciences, Disease severity, Antiviral Agent, Hepaciviru, Hepatology, business.industry, Settore MED/09 - MEDICINA INTERNA, medicine.disease, digestive system diseases, Direct acting antiviral, business, Demography
Abstract

Background: Direct-acting antivirals are highly effective for the treatment of hepatitis C virus (HCV) infection, regardless race/ethnicity. We aimed to evaluate demographic, virological and clinical data of HCV-infected migrants vs. natives consecutively enrolled in the PITER cohort. Methods: Migrants were defined by country of birth and nationality that was different from Italy. Mann-Whitney U test, Chi-squared test and multiple logistic regression were used. Results: Of 10,669 enrolled patients, 301 (2.8%) were migrants: median age 47 vs. 62 years, (p < 0.001), females 56.5% vs. 45.3%, (p < 0.001), HBsAg positivity 3.8% vs. 1.4%, (p < 0.05). Genotype 1b was prevalent in both groups, whereas genotype 4 was more prevalent in migrants (p < 0.05). Liver disease severity and sustained virologic response (SVR) were similar. A higher prevalence of comorbidities was reported for natives compared to migrants (p < 0.05). Liver disease progression cofactors (HBsAg, HIV coinfection, alcohol abuse, potential metabolic syndrome) were present in 39.1% and 47.1% (p > 0.05) of migrants and natives who eradicated HCV, respectively. Conclusion: Compared to natives, HCV-infected migrants in care have different demographics, HCV genotypes, viral coinfections and comorbidities and similar disease severity, SVR and cofactors for disease progression after HCV eradication. A periodic clinical assessment after HCV eradication in Italians and migrants with cofactors for disease progression is warranted.

Published
2021

40. Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Author

Francesco Giuseppe Foschi, Gianpaolo Vidili, Andrea Mega, Antonio Gasbarrini, Marco Zoli, Edoardo G. Giannini, Rodolfo Sacco, Alessandro Vitale, Francesco Tovoli, Giacomo Laffi, Maria Di Marco, Giovanni Raimondo, Gianluca Svegliati-Baroni, Claudia Campani, Francesco Azzaroli, Fabio Farinati, Umberto Arena, Fabio Marra, Gabriele Dragoni, Alberto Masotto, Franco Trevisani, Maurizia Rossana Brunetto, Giuseppe Cabibbo, Elisabetta Biasini, Gian Ludovico Rapaccini, Eugenio Caturelli, Gerardo Nardone, Maria Guarino, Umberto Cillo, Campani, C., Vitale, A., Dragoni, G., Arena, U., Laffi, G., Cillo, U., Giannini, E. G., Tovoli, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Mega, A., Guarino, M., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Biasini, E., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Brunetto, M. R., Farinati, F., Trevisani, F., Marra, F., Campani C., Vitale A., Dragoni G., Arena U., Laffi G., Cillo U., Giannini E.G., Tovoli F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Sacco R., Cabibbo G., Mega A., Guarino M., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Biasini E., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Brunetto M.R., Farinati F., Trevisani F., and Marra F.

Subjects
ALBI grade, Barcelona Clinic Liver Cancer, Cancer of the Liver Italian Program, ITALICA staging system, MESIAH, medicine.medical_specialty, lcsh:RC254-282, Gastroenterology, Internal medicine, Medicine, In patient, Radiologic Response, Settore MED/12 - Gastroenterologia, Original Paper, Hepatology, business.industry, Proportional hazards model, Confounding, Hazard ratio, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Oncology, Hepatocellular carcinoma, Akaike information criterion, business, Liver cancer
Abstract

Introduction: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. Results: The median OS of the enrolled patients was 41 months. According to LRT χ2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10–1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. Conclusion: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.

Published
2021

41. Plasma dosage of ghrelin, IGF-1, GLP- 1 and leptin related to gastric emptying and esophageal pH-impedance in children with obesity

Author

Gerardo Nardone, Alba Rocco, Enza Mozzillo, Paolo Quitadamo, Annamaria Staiano, V. Giorgio, Adriana Franzese, Letizia Zenzeri, Quitadamo, P., Zenzeri, L., Mozzillo, E., Giorgio, V., Rocco, A., Franzese, A., Nardone, G., and Staiano, A.

Subjects
Leptin, Male, medicine.medical_specialty, Esophageal pH Monitoring, Gastrointestinal Diseases, Endocrinology, Diabetes and Metabolism, Gastric motility, 030209 endocrinology & metabolism, Gastric emptying, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Glucagon-Like Peptide 1, Internal medicine, medicine, Humans, pH-impedance monitoring, Obesity, Insulin-Like Growth Factor I, Child, Correlation of Data, Breath test, medicine.diagnostic_test, business.industry, digestive, oral, and skin physiology, medicine.disease, Hormone, digestive system diseases, Ghrelin, Gastroesophageal reflux, 030220 oncology & carcinogenesis, GERD, Quality of Life, Female, business
Abstract

Purpose: The main aim of the study was to assess the relationship between leptin, ghrelin, insulin-like growth factor 1 (IGF-1), and glucagon-like peptide 1 (GLP-1) blood levels and gastric motility in children with obesity compared to healthy children. Secondary aims were to assess the possible association between these hormones and obesity, reflux impedance parameters, reflux symptoms, other GI disorders, and quality-of-life scores within the same groups. Methods: Children with obesity plus GERD symptoms and 2 control groups of children with obesity without GERD and healthy lean children aged 4–17 years underwent an auxological evaluation, an assessment of gastro-intestinal symptoms and quality of life, hormonal dosages, and an evaluation of gastric emptying time (GET) through 13C-octanoic acid breath test. Results: No significant association was found between hormones and gastric motility. Leptin and ghrelin levels were significantly associated with obesity parameters. No significant differences were found between GET and hormones of the patients with obesity, either with or without GERD. Conclusion: Although we found an association between auxological parameters and both leptin and ghrelin levels, this association did not imply an effect on the upper GI motility. Therefore, our hypothesis that alterations of these hormones in children with obesity could affect gastric emptying, triggering GERD, was not supported by our data.

Published
2021

42. Impact of proton pump inhibitors on cytochrome P450 activity assessed by

Author

Alba, Rocco, Debora, Compare, Costantino, Sgamato, Pietro, Coccoli, Paolo, Chiodini, and Gerardo, Nardone

Subjects
Liver Cirrhosis, Breath Tests, Cytochrome P-450 Enzyme System, Rabeprazole, Humans, Esomeprazole, Lansoprazole, Proton Pump Inhibitors, Aminopyrine, Anti-Ulcer Agents, 2-Pyridinylmethylsulfinylbenzimidazoles
Abstract

Chronic use of proton pump inhibitors (PPIs) in patients with impaired liver function may worsen cytochrome P450 (CYP450) activity, predisposing them to clinically relevant drug-drug interactions. TheTo assessAt baseline, mean values of maxIn patients with cirrhosis, omeprazole, esomeprazole and lansoprazole inhibit microsomal activity while pantoprazole and rabeprazole do not have a significant impact. Should our data be confirmed in larger cohort studies, pantoprazole and rabeprazole could be safely recommended for patients with cirrhosis.

Published
2020

44. Non-bismuth and bismuth quadruple therapies based on previous clarithromycin exposure are as effective and safe in an area of high clarithromycin resistance: A real-life study

Author

C. Mucherino, Rocco Maurizio Zagari, Agnese Miranda, Luciana Avallone, Franco Bazzoli, Lorenzo Romano, A. Romiti, Carmelina Loguercio, Katerina Priadko, Debora Compare, Lucia Granata, Marco Martorano, Marco Romano, Antonietta Gerarda Gravina, Alessandro Federico, Concetta Tuccillo, Gerardo Nardone, Maria Raffaella Romito, D. Sgambato, Marcello Dallio, Romano, M., Gravina, A. G., Nardone, G., Federico, A., Dallio, M., Martorano, M., Mucherino, C., Romiti, A., Avallone, L., Granata, L., Priadko, K., Compare, D., Tuccillo, C., Romito, M. R., Sgambato, D., Miranda, A., Romano, L., Loguercio, C., Bazzoli, F., Zagari, R. M., Romano M., Gravina A.G., Nardone G., Federico A., Dallio M., Martorano M., Mucherino C., Romiti A., Avallone L., Granata L., Priadko K., Compare D., Tuccillo C., Romito M.R., Sgambato D., Miranda A., Romano L., Loguercio C., Bazzoli F., and Zagari R.M.

Subjects
Adult, Male, medicine.medical_specialty, Gastroenterology, Drug Administration Schedule, Helicobacter Infections, Internal medicine, Clarithromycin, Clarithromycin resistance, Drug Resistance, Bacterial, Medicine, Humans, Helicobacter, antimicrobial resistance, Adverse effect, High prevalence, biology, Helicobacter pylori, business.industry, non-bismuth quadruple therapy, General Medicine, Middle Aged, biology.organism_classification, bacterial infections and mycoses, Pylera, Anti-Bacterial Agents, Regimen, Infectious Diseases, Treatment Outcome, Case-Control Studies, Patient Compliance, Drug Therapy, Combination, Female, Antacids, business, Life study, Bismuth, medicine.drug
Abstract

Background: Bismuth quadruple (BQT) and non-bismuth quadruple (N-BQT) therapies are the recommended first-line treatments for Helicobacter (H.) pylori infection. Objective: To compare the efficacy of BQT and N-BQT in clinical practice in an area with high clarithromycin resistance, choosing the regimen on the basis of previous exposure to clarithromycin. Methods: A total of 404 consecutive Hpylori-positive, naïve patients were enrolled. A total of 203 patients without previous exposure to clarithromycin received N-BQT, 100 patients for 10days and 103 for 14days, whereas 201 with previous exposure to clarithromycin received 10-day BQT. Efficacy and treatment-related adverse events were assessed. Results and Conclusions: Eradication rates by intention-to-treat analysis were 88.2% for N-BQT and 91.5% for BQT (P=.26); per-protocol analysis eradication rates were 91.2% and 95.8% for N-BQT and BQT, respectively (P=.07). Eradication rates were significantly higher with 14-day than 10-day CT (P&nbsp

Published
2020

45. Characterization of the duodenal mucosal microbiome in obese adult subjects by 16s rrna sequencing

Author

Lucia Sacchetti, Mario Rosario Guarracino, Carmela Nardelli, Valeria D'Argenio, Debora Compare, Vincenzo Pilone, Salvatore Tramontano, Gerardo Nardone, Ilaria Granata, Nardelli, C, Granata, I, D'Argenio, V, Tramontano, S, Compare, D, Guarracino, M R, Nardone, G, Pilone, V, and Sacchetti, L

Subjects
Microbiology (medical), obesity, biology, Atopobium, Firmicutes, Communication, Lachnospiraceae, duodenum, microbiome, Physiology, Fusobacteria, Gut flora, biology.organism_classification, medicine.disease, Duodenum, Microbiome, Obesity, Microbiology, lcsh:Biology (General), Virology, medicine, Proteobacteria, Dysbiosis, lcsh:QH301-705.5
Abstract

The gut microbiota may have an impact on obesity. To date, the majority of studies in obese patients reported microbiota composition in stool samples. The aim of this study was to investigate the duodenal mucosa dysbiosis in adult obese individuals from Campania, a region in Italy with a very high percentage of obese people, to highlight microbial taxa likely associated with obesity. Duodenum biopsies were taken during upper gastrointestinal endoscopy in 19 obese (OB) and 16 lean control subjects (CO) and microbiome studied by 16S rRNA gene sequencing. Duodenal microbiome in our groups consisted of six phyla: Proteobacteria, Firmicutes, Actinobacteria, Fusobacteria, Bacteroidetes and Acidobacteria. Proteobacteria (51.1% vs. 40.1%) and Firmicutes (33.6% vs. 44.9%) were significantly (p < 0.05) more and less abundant in OB compared with CO, respectively. Oribacterium asaccharolyticum, Atopobium parvulum and Fusobacterium nucleatum were reduced (p < 0.01) and Pseudomonadales were increased (p < 0.05) in OB compared with CO. Receiver operating characteristic curve analysis showed Atopobium and Oribacterium genera able to discriminate with accuracy (power = 75% and 78%, respectively) OB from CO. In conclusion, increased Proteobacteria and decreased Firmicutes (Lachnospiraceae) characterized the duodenal microbiome of obese subjects. These data direct to further studies to evaluate the functional role of the dysbiotic-obese-associated signature.

Published
2020

46. Pharmacological treatment of gastrointestinal bleeding due to angiodysplasias: A position paper of the Italian Society of Gastroenterology (SIGE)

Author

Debora Compare, Alberto Martino, Alba Rocco, Gerardo Nardone, Nardone, Gerardo, Compare, Debora, Martino, Alberto, and Rocco, Alba

Subjects
Gastrointestinal bleeding, medicine.medical_specialty, Psychological intervention, Gastroenterology, Somatostatin analogue, Angiodysplasia, 03 medical and health sciences, Therapeutic approach, 0302 clinical medicine, Internal medicine, medicine, Humans, Medical prescription, Progesterone, Societies, Medical, Randomized Controlled Trials as Topic, Gastrointestinal tract, Hepatology, business.industry, medicine.disease, Thalidomide, Treatment Outcome, Italy, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Quality of Life, Hormonal therapy, 030211 gastroenterology & hepatology, Gastrointestinal Hemorrhage, Somatostatin, business, Human, medicine.drug
Abstract

Angioectasias (AD) belong to benign vascular malformations of the gastrointestinal tract and are responsible for about 4-7% of upper non variceal bleeding, 30-40% of small bowel occult bleeding and 3-40% of colonic bleeding episodes. Gastrointestinal haemorrhage secondary to AD represents an important diagnostic and therapeutic problem that negatively impacts on the quality of life of patients and heath care costs. Endoscopic interventions are the mainstay in both diagnosis and treatment of vascular malformations. However, in a substantial percentage of the cases, age of the patients, comorbidities, clinical severity of anaemia and blood loss as well as size, site and number of lesions prevent this therapeutic approach. Hormonal therapy, thalidomide and somatostatin analogues have been investigated for their potential role as rescue therapies in controlling AD bleeding although, thus far, no recommendations have been provided on their use in this clinical setting. In order to implement appropriate prescription of pharmacological agents to manage gastrointestinal bleeding due to ADs, the Italian Society of Gastroenterology (SIGE) nominated a panel of experts who reviewed the available clinical literature and produced practical clinical recommendations.

Published
2018

47. Adherence to Barcelona Clinic Liver Cancer guidelines in field practice: Results of Progetto Epatocarcinoma Campania

Author

Luigi Elio Adinolfi, Giorgio de Stefano, Raffaella Tortora, Angelo Salomone Megna, Vincenzo De Girolamo, Maria Guarino, Marcello Persico, Giovanni Battista Gaeta, Nicola Coppola, Francesco Izzo, Vincenzo Messina, Giuseppe D'Adamo, Gerardo Nardone, Giovan Giuseppe Di Costanzo, Carmine Coppola, Guido Piai, Filomena Morisco, and Giampiero Francica

Subjects
medicine.medical_specialty, Multivariate analysis, Hepatology, business.industry, Gastroenterology, medicine.disease, Thrombosis, digestive system diseases, BCLC Stage, Surgery, Portal vein thrombosis, 03 medical and health sciences, 0302 clinical medicine, Field practice, 030220 oncology & carcinogenesis, Internal medicine, medicine, 030211 gastroenterology & hepatology, Liver function, Stage (cooking), Liver cancer, business
Abstract

Background The BCLC algorithm is the standard system for clinical management of HCC. Data on adherence to this therapeutic paradigm are scarce. Aims This field-practice study aimed to provide a description of HCC cirrhotic patients in Southern Italy, to evaluate the adherence to BCLC guidelines and its impact on patients’ survival. Methods We analyzed the region-wide Italian database of Progetto Epatocarcinoma Campania, which includes data of HCC cirrhotic patients, prospectively collected from January 2013 to December 2015 in 16 regional centers. Results Overall 1008 HCC patients were enrolled: 70.6% patients received therapies recommended by BCLC algorithm, while 29.4% underwent different treatments. Among patients who were treated in adherence to guidelines, a higher rate of diagnosis on surveillance programs, better liver function, lower rate of AFP >200ng/ml, more early stage and monofocal HCC, lower frequency of nodules >5cm, portal vein thrombosis and metastases were observed. The overall survival was evaluated according to HCC stage and no differences between group and patients managed differently were found. The multivariate analysis showed that non-adherence to treatment guidelines was independently associated to the BCLC stage B, Child-Pugh classes B-C, and to the presence of neoplastic thrombosis and metastases. Conclusion Adherence to BCLC algorithm in field-practice was high in early and end stage HCC patients, but it was poor in intermediate and advanced patients.

Published
2018

48. What's New in Diagnosing Diverticular Disease

Author

Giovanni Maconi, Francesco Di Mario, Davor Štimac, A. Violi, Andrea Mazzari, Antonio Tursi, Gerardo Nardone, Antonio Crucitti, Walter Elisei, Stimac, D., Nardone, G., Mazzari, A., Crucitti, A., Maconi, G., Elisei, W., Violi, A., Tursi, A., and Di Mario, F.

Subjects
medicine.medical_specialty, Abdominal pain, Computer tomography, diverticular disease, Colonoscopy, Inflammatory bowel disease, Gastroenterology, Diagnosis, Differential, Acute diverticulitis, DICA classification, Diverticular disease, Fecal calprotectin, Ultrasonography, acute diverticulitis, colonoscopy, computer tomography, ultrasonography, fecal calprotectin, Internal medicine, medicine, Humans, BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Internal Medicine, Diverticuliti, Diverticulitis, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Interna medicina, Diverticular Diseases, medicine.diagnostic_test, business.industry, Biomarker, medicine.disease, Diverticulosis, Acute diverticuliti, Acute Disease, Biomarker (medicine), Calprotectin, medicine.symptom, Differential diagnosis, business, Tomography, X-Ray Computed, Biomarkers, Human
Abstract

In this session different issues for the diagnosis of diverticular disease (DD) were considered including “Biomarkers”, “Computer tomography”, “Ultrasonography in detecting acute diverticulitis”, “Endoscopy” and “The DICA classification: a new predictive tool in managing diverticular disease”. Most patients affected by DD suffer from recurrent attacks of abdominal pain without evidence of an active inflammatory process, causing a difficult differential diagnosis with other intestinal conditions. Several biomarkers, serological, fecal, urinary and genetic were considered, but recent studies confirmed that only CRP and fecal calprotectin are matching with the criteria for an ideal biomarker for DD. Colonoscopy still remains the gold standard for the diagnosis of DD, playing a key role in many clinical settings, such as colonic diverticular bleeding, or to differentiate inflammatory bowel disease (IBD) and segmental colitis associated with diverticulosis (SCAD); Moreover, in 2015 has been developed the DICA (Diverticular Inflammation and Complication Assessment) endoscopic classification that considers 10 different parameters, each one with a score, and the sum of items scores represents the severity of the disease; in this way the endoscopic exam would be able to predict the outcome of DD for each patient. On the other hand, computer tomography (CT) is the gold standard for acute diverticulitis (AD) with an excellent sensitivity and specificity; recently, metanalysis of prospective studies have shown that intestinal ultrasonography (IUS) and CT have the same sensitivity for the diagnosis of an AD and the advantage is that IUS is less expensive, non-invasive and easily accessible.

Published
2019

49. Gastric Normal Adjacent Mucosa Versus Healthy and Cancer Tissues: Distinctive Transcriptomic Profiles and Biological Features

Author

Giovanni Calice, Francesco La Rocca, Vitalba Ruggieri, Mario De Felice, Gerardo Nardone, Pellegrino Musto, Geppino Falco, Simona Laurino, Cinzia Lapadula, Sabino Russi, Pietro Zoppoli, Elena Amendola, Debora Compare, Russi, Sabino, Calice, Giovanni, Ruggieri, Vitalba, Laurino, Simona, Rocca, Francesco La, Amendola, Elena, Lapadula, Cinzia, Compare, Debora, Nardone, Gerardo, Musto, Pellegrino, Felice, Mario De, Falco, Geppino, and Zoppoli, Pietro

Subjects
0301 basic medicine, Cancer Research, gastric cancer, Normal tissue, Estrogen receptor, Computational biology, normal tissue adjacent to the tumor, gene expression profile, Gene signature, Biology, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, lcsh:RC254-282, Article, Transcriptome, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Oncology, Nat, 030220 oncology & carcinogenesis, Cancer genome, Gene expression, Gnat
Abstract

Gastric cancer (GC) is a leading cause of cancer-related deaths in the world. Molecular heterogeneity is a major determinant for the clinical outcomes and an exhaustive tumor classification is currently missing. Histologically normal tissue adjacent to the tumor (NAT) is commonly used as a control in cancer studies, nevertheless a recently published paper described the unique characteristics of the NAT in several tumor types. Little is known about the global gene expression profile of gastric NAT (gNAT) which could be an effective tool for a more realistic definition of GC molecular signature. Here, we integrated data of 512 samples from the Genotype-Tissue Expression project (GETx) and The Cancer Genome Atlas (TCGA) to analyze the transcriptome of healthy gastric tissues, gNAT, and GC samples. We validated TCGA-GETx data mining through inHouse gNAT and GC expression dataset. Differential gene expression together with pathway enrichment analyses, indeed, led to different results when using the gNAT or the healthy tissue as control. Based on our analyses, gNAT showed a peculiar gene signature and biological features, like the estrogen receptor pathways activation, suggesting a molecular behavior partially different from both healthy and GC tissues. Therefore, using gNAT as healthy control tissue in the characterization of tumor associated biological processes and pathways could lead to suboptimal results.

Published
2019
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50. Invasive pulmonary aspergillosis and pulmonary tuberculosis in a patient treated with infliximab for Crohn's disease

Author

Debora Compare, Giulio Viceconte, Emanuela Zappulo, Maria Vargas, Giuseppe Servillo, Guglielmo Borgia, Antonio Riccardo Buonomo, Gerardo Nardone, Ivan Gentile, Carmine Iacovazzo, Buonomo, A. R., Viceconte, G., Compare, D., Vargas, M., Iacovazzo, Carmine, Zappulo, E., Nardone, G., Servillo, G., Borgia, G., and Gentile, I.

Subjects
0301 basic medicine, medicine.medical_specialty, Tuberculosis, Pleural effusion, 030106 microbiology, Infectious and parasitic diseases, RC109-216, Amiodarone, Invasive pulmonary aspergillosis, Article, 03 medical and health sciences, 0302 clinical medicine, Maintenance therapy, Moxifloxacin, Internal medicine, medicine, 030212 general & internal medicine, business.industry, Isavuconazole, Invasive pulmonary aspergillosi, medicine.disease, Infliximab, Pneumonia, Infectious Diseases, Respiratory failure, business, medicine.drug
Abstract

Highlights • Pulmonary TB together with invasive pulmonary aspergillosis due to infliximab therapy has been occasionally described. • Other than tuberculosis reactivation, TNF-α antagonists may be associated with other opportunistic infections such as invasive aspergillosis. • Interactions among rifamycins, antifungal and antiarrhythmic drugs are complex and may require the choice of second line therapies. • Isavuconazole may have a better interaction profile with amiodarone and antitubercular therapy than voriconazole., We report a case of concurrent development of active pulmonary tuberculosis and invasive pulmonary aspergillosis (IPA) in a patient who received therapy with infliximab for Crohn’s disease. He has been treated with antitubercular therapy and liposomal amphotericin B for 8 weeks. His clinical course was complicated by paroxysmal atrial fibrillation requiring maintenance therapy with amiodarone, respiratory failure due both to pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamases (ESBL)-producing Klebsiella pneumoniae and pleural effusion requiring chest drainage. At discharge, a maintenance regimen based on the administration of isavuconazole 200 mg daily, moxifloxacin 400 mg daily and isoniazid 300 mg daily was chosen to avoid multiple drug-drug interaction between rifamycins, antifungal triazole agents and antiarrhythmic drugs. At 3 months of follow-up his clinical conditions were dramatically improved, high resolution chest tomography (HRCT) showed reduction of parenchymal lesions and no changes both in sinus rhythm and QTc interval were noticed. Besides the complexity and the peculiarity of the clinical scenario, this case underlines the risk of invasive fungal infections linked to the administration of TNF-α antagonists in gastroenterological setting and the importance of accurate evaluation of drug-drug interactions when choosing the antimicrobial therapies.

Published
2019

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