Enrico Colombo

Prognostic Significance of Endoscopic Remission in Patients with Active Ulcerative Colitis Treated with Oral and Topical Mesalazine: A Prospective, Multicenter Study

Background: It has been recommended that the treatment of active ulcerative colitis (UC) should be continued until complete healing of endoscopic lesions. However, the evidence supporting this recommendation is scanty. Aims of the present study were to assess the rate of patients with active UC who achieve clinical but not endoscopic remission after treatment with oral plus topical mesalazine and to compare the rate of relapse in patients with clinical/endoscopic remission and those with only clinical remission. Methods: Patients with active mild or moderate UC were eligible. All patients received mesalazine, 4 g/day orally and 2 g/day per rectum for 6 weeks. Those achieving clinical remission underwent colonoscopy: afterwards, all received maintenance treatment with oral mesalazine, 2 g/day orally for 1 year. Clinical remission was defined as normal frequency of bowel movements with formed stools, no abdominal pain, and no blood in the stools. Endoscopic remission was defined as normal‐appearing mucosa or only mild redness and/or friability, without either ulcers or erosions. Results: In all, 81 patients were enrolled. Sixty‐one (75%) achieved clinical remission. Endoscopic activity was still present in five (8%). The cumulative rate of relapse at 1 year was 23% in patients with clinical and endoscopic remission and 80% in patients with only clinical remission (P < 0.0001). Conclusions: Persistence of endoscopic activity is quite infrequent in patients with active UC achieving clinical remission after a 6‐week treatment with oral plus topical mesalazine, but is a very strong predictor of early relapse. (Inflamm Bowel Dis 2012;)

Pregnancy before and after the diagnosis of inflammatory bowel diseases: Retrospective case–control study

Background and Aim:  Inflammatory bowel diseases (IBD) commonly affect women during the reproductive years. The aim of the present study was to evaluate the reproductive histories of patients with ulcerative colitis (UC) and Crohns disease (CD) considering pregnancies occurring before and after the diagnosis.

Prevalence and risk factors of Helicobacter pylori-negative peptic ulcer: a multicenter study.

Peptic ulcer disease (PUD) has been described in the absence of Helicobacter pylori (Hp) infection, suggesting that different factors are involved in its etiopathogenesis. We investigated prevalence and characteristics of Hp-negative (Hp-) PUD in an area of Northern Italy and calculated the rate of Hp-positive (Hp+) patients with PUD in whom Hp might be coincidental and not causal. Four hundred nine consecutive patients with endoscopically diagnosed PUD were enrolled in seven hospitals. Hp infection was assessed by rapid urease test and histologic examination. The attributable risk percentages in different age groups were calculated by appropriate formulas. Of 409 patients, 31 (7.6%) were Hp- (gastric, 8.3%; duodenal, 7.6%). Age, nonsteroidal antiinflammatory drug (NSAID) consumption, and complication rates were significantly higher in Hp-than Hp+ patients with duodenal ulcers (DUs). Of the Hp-patients with DU, 58% did not use NSAIDs. In patients with Hp+ DU, the attributable risk percentage for Hp infection in patients aged <40 years, 40-60 years, or >60 years was 98%, 88%, and 66%, respectively. The prevalence of Hp- PUD was about 8%, mainly unrelated to any known etiologic factor. In about one-third of Hp+ patients with PUD aged over 60 years, Hp infection might be coincidental and not causal.

The use of thiopurines for the treatment of inflammatory bowel diseases in clinical practice.

BACKGROUND Thiopurines are the most commonly used immunomodulatory drugs in inflammatory bowel diseases. AIM To evaluate the use, the therapeutic and safety profiles of thiopurines in a large sample of IBD patients. METHODS We reviewed 3641 case histories of IBD patients. Thiopurines were prescribed in 582 patients (16.0%); the analysis was performed on the 553 (267 ulcerative colitis, 286 Crohns disease) with exhaustive clinical data. RESULTS The main indications for treatment were steroid-dependence (328/553, 59.3%) and steroid-resistance (113/553, 20.7%). Thiopurines were started when CD were younger than UC patients (p<0.001) but earlier from diagnosis in UC than in CD patients (p=0.003). Efficacy was defined as optimal (258/553, 46.6%), partial (108/553, 19.5%), absent (85/553, 15.4%) and not assessable (102/553, 18.4%). Efficacy was independent of disease type, location/extension or duration and age at starting. Side effects were observed in 151/553 (27.3%) patients, leading to drug discontinuation in 101 (18.3%). 15 out of the 130 (11.5%) patients who took thiopurines for more than 4 years relapsed, more frequently in CD than in UC (OR=3.67 95% C.I. 0.98-13.69; p=0.053). CONCLUSIONS Thiopurines confirm their clinical usefulness and acceptable safety profile in managing complicated IBD patients. The majority of patients treated for longer than 4 years maintain response. No clinical and demographic predictive factors for efficacy and side effects were identified.

Prediction of oesophageal variceal bleeding: evaluation of the Beppu and North Italian Endoscopie Club scores by an independent group

Objective: To evaluate the prediction of variceal bleeding by the Beppu (Japanese Research Society for Portal Hypertension) and NIEC (North Italian Endoscopie Club) scores in groups of patients with different investigators. Methods: A total of 200 patients with liver cirrhosis and endoscopically proven oesophageal varices, but without any previous gastrointestinal bleeding, were enrolled and followed up for 12 months. Results: Overall, 191 patients were evaluated. The Beppu score classified patients into categories of bleeding risk (P=0.0055), but the actual bleeding rates were significantly different from those predicted by the score (P< 0.001 ). The Beppu score overestimated the risk of variceal bleeding, particularly for high-risk groups. The NIEC score also classified patients according to bleeding risk (P= 0.0260), but the expected and observed cumulative bleeding rates were not significantly different for any group (P=0.123). This score was more accurate, although it overestimated bleeding risk by a factor of 2.4, on average. Conclusion: Our data confirm that the Beppu and NIEC scores can identify groups of patients at risk of variceal bleeding. However, the latters prediction of risk is closer to the actual bleeding rate, despite some overestimation.

Lack of colonic neoplastic lesions in patients under 50 yr of age with hematochezia : A multicenter prospective study

OBJECTIVES: It is still not clear what is the best way of evaluating rectal bleeding in young people. Our aim was to examine the prevalence of neoplastic colonic lesions in these patients.METHODS: This prospective, multicenter study enrolled 622 patients aged 30–50 yr (F 232/M 390) consecutively seen in 14 open-access endoscopy departments for hematochezia, defined as bright red blood from the rectum, red blood noted either in the feces, on toilet paper, or in the toilet bowl. At colonoscopy, pathology was stratified as either proximal or distal to the splenic flexure. Exclusion criteria were a history of colitis, colorectal cancer, polyps, anemia, significant weight loss, severe bleeding, or strong family history of colorectal cancer.RESULTS: Malignant polyps were found in two patients (0.6%), aged 30–40 yr, one in the rectum and one in the sigmoid. A malignant polyp of the cecum was found in a 41-yr-old patient. Another, aged 47, had a malignant granular-cell tumor of the rectum. A total of 35 advanced adenomas were identified in 18 patients. In 7 patients (2.2 %) within the 30–40 yr age bracket we found 8 advanced adenomas (all in the rectum/sigmoid). The other 27 advanced adenomas were in 11 patients (3.5%) in the 41–50 yr age bracket. In this age group we observed 3 patients with 10 isolated proximal advanced adenomas.CONCLUSIONS: In patients younger than 40 yr with hematochezia, advanced neoplastic lesions are rare and usually located in the rectum and sigmoid colon. Sigmoidoscopy appears to be sufficient for evaluation in these patients.

Is liver biopsy routinely required before interferon treatment for chronic HCV hepatitis

IS LIVER BIOPSY ROUTI NELY REQUIRED BEFORE INTER· FERON TREATMENT FOR CHRONIC HCV HEPATITIS? Natalia Terreni, Gianni Gualdoni, Roberta Padalino, Anna Toldi, Luca Ferraris, Enrico Colombo, Maurizio Fossati, Maria A. Casiraghi, Giorgio Minoli, Valduce Hosp, Como, Italy; Legnano Hosp, Legnano (MI), Italy; Varese Hosp, Varese, Italy; Garbagnate Hosp, Garbagnate (MI). Italy; Merate Hosp, Merate (CO), Italy.

OC.11.4 LONG TERM EFFICACY OF GRANULOCYTE-MONOCYTE-APHERESIS IN ULCERATIVE COLITIS. THE ITALIAN REGISTRY OF THERAPEUTIC APHERESIS

G A A b st ra ct s These cases were divided into two groups according to the period of availability of infliximab (IFX): pre-IFX (N=94, Jan. 1975 Jun. 2001) and post-IFX (N=88, Jul. 2001 Jun. 2009). Results: The perianal lesions were observed in 36.3% of CD patients, more common in male, and diagnosed at younger age than CD without perianal lesions. Fistula was the most prevalent lesion, followed by abscess, fissure, and stricture. Perianal lesions preceded abdominal symptoms such as pain and diarrhea in 25% of the cases. In post-IFX group, the remission rates with non-specific conservative management, specific medical treatment, surgical treatment, and combined surgical and medical treatment were 17%, 73%, 58%, and 72%, respectively. The remission rate of combined treatment in post-IFX group was significantly higher than that in pre-IFX group. Cumulative relapse rates in 1, 3, and 5 years were 9.4%, 31.3%, and 41.7%, respectively. Medical maintenance treatment was the only significant factor that lowers the relapse rates (p<0.01). Conclusions: These results suggest that initial medical treatment is effective and maintenance therapy lowers the recurrence rates in CD patients with perianal lesions.