Silvia Mazzuoli

Catheter-related complications in long-term home parenteral nutrition patients with chronic intestinal failure.

Background Home Parenteral Nutrition is a therapeutic option to improve quality of life in chronic intestinal failure. Aims To describe frequency of complications both in cancer and non-cancer patients. Methods This study was performed on 270 adult patients (52% with cancer, 48% without cancer) followed for a total of 371 years of treatment. Mean duration of therapy was 191±181 for cancer and 830±1168 days/patient for non-cancer. The treatment was administered by a competent, dedicated provider. Patients received our prescribed “all-in-one admixtures” at their homes. Results Catheter-related complications/1000-days-catheter was 1.40; mechanical complications were comparable in cancer (0.82) and non-cancer (0.91) patients while a statistically significant difference was observed between cancer (0.71) and non-cancer (0.46) patients for sepsis. Bacterial infections were more frequent in non-cancer, mycotic infections primarily affected cancer patients. In our experience 49% of the patients were readmitted, with a low incidence rate of 0.89/1000 days-catheter. The incidence of hepatobiliary complications in our population was 65%. The degree of liver damage was related to short bowel syndrome and to length of treatment. Conclusions This study indicated that cancer patients are more vulnerable to CVC-related infections during Home Parenteral Nutrition and that a safer Home Parenteral Nutrition protocol should be adopted in order to contain CVC-related complications.

Undernutrition, risk of malnutrition and obesity in gastroenterological patients: A multicenter study

AIM To investigate the prevalence of undernutrition, risk of malnutrition and obesity in the Italian gastroenterological population. METHODS The Italian Hospital Gastroenterology Association conducted an observational, cross-sectional multicenter study. Weight, weight loss, and body mass index were evaluated. Undernutrition was defined as unintentional weight loss > 10% in the last three-six months. Values of Malnutrition Universal Screening Tool (MUST) > 2, NRS-2002 > 3, and Mini Nutritional Assessment (MNA) from 17 to 25 identified risk of malnutrition in outpatients, inpatients and elderly patients, respectively. A body mass index ≥ 30 indicated obesity. Gastrointestinal pathologies were categorized into acute, chronic and neoplastic diseases. RESULTS A total of 513 patients participated in the study. The prevalence of undernutrition was 4.6% in outpatients and 19.6% in inpatients. Moreover, undernutrition was present in 4.3% of the gastrointestinal patients with chronic disease, 11.0% of those with acute disease, and 17.6% of those with cancer. The risk of malnutrition increased progressively and significantly in chronic, acute and neoplastic gastrointestinal diseases in inpatients and the elderly population. Logistical regression analysis confirmed that cancer was a risk factor for undernutrition (OR = 2.7; 95%CI: 1.2-6.44, P = 0.02). Obesity and overweight were more frequent in outpatients. CONCLUSION More than 63% of outpatients and 80% of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment.

Management of ulcerative colitis in a real-life setting: An Italian multicenter, prospective, observational AIGO study

BACKGROUND No data are available on the variability in the clinical management of ulcerative colitis (UC) patients by Italian gastroenterologists. Therefore, improving the standards of UC care as provided by the National Welfare Clinical Path (PDTA), in accordance with the European Crohns and Colitis Organization (ECCO) guidelines for UC, is not easy. AIMS To assess the management of UC by Italian gastroenterologists in a real-life setting taking into account its variability. METHODS This prospective, cross-sectional, observational study included IBD-specialized gastroenterologists (GSIBDs) and general gastroenterologists (GGs) working in Italian public hospital units. Consecutive patients with an UC flare were enrolled and the medical treatment evaluated. For each center, the physician in charge of the study (16 GSIBDs and 10 GGs) was administered two electronic questionnaires. RESULTS Among 26 units, 573 UC patients were enrolled. Good adherence to the European guidelines was reported; GSIBDs reported greater adherence than GGs with a higher prescription of rectal and combination therapy in mild to moderate distal disease and a higher rate of hospitalization in severe UC. CONCLUSION The management of UC by Italian gastroenterologists in clinical practice is good according to the ECCO consensus recommendations, though some discrepancies are present between GSIBDs and GGs.

Introduction to the Minisymposium on mucosal healing in inflammatory bowel disease

Mucosa healing (MH) currently represents the primary endpoint o verify the efficacy of any pharmacological treatment in inflamatory bowel disease (IBD). In fact, many studies have highlighted hat gastroenterologists’ attitude towards MH changed drastically hen anti-TNF therapy was introduced, and determined a rapid nd unexpected improvement in clinical symptoms and endoscopic esions. Persistence of mucosal inflammation, even in the absence f symptoms, is a recognized risk factor for disease relapse and ecurrence and has recently been associated with increased risk f colorectal cancer (1–5) in ulcerative colitis (UC). It has also been roven that MH strongly correlates with the reduction of: (i) length f hospital stay (6–8), (ii) frequency of medical and surgical comlications (9, 10) and (iii) surgical interventions (11–13). Moreover it has been demonstrated that MH has an important ole in predicting “sustained clinical remission” induced by biologcal therapy and that, its occurrence, can be considered a positive vent, as it can potentially modify the clinical outcome of IBD, espeially in patients with ulcerative recto-colitis. Many open questions still remain, including: What are the preictive factors of MH? Is the diagnosis of MH simply based on ndoscopic data or does it require histological examination? Which s the contribution of imaging techniques to MH diagnosis? Which s the role of MH in the clinical management of IBD? What is the pecific regional experience of gastroenterologists in MH? In order to attempt to answer some of these key questions dedicated meeting on MH in IBD was organized in September 011 in Trani, Italy; local and nationally recognized expert gasroenterologists, endoscopists, radiologists and pathologists were nvited to submit their personal contribution/opinion focusing on everal controversial key issues. The results of the meeting emphasized the opinion that MH eeds to be validated and requires more prospective studies to conrm the utility of the use of endoscopy, as a frequent and regular iagnostic tool, in evaluating and guiding changes in therapy during ollow-up of IBD patients. Furthermore, the pathologists reinforced he concept that endoscopy with intestinal biopsy represents an mportant tool in the therapeutic decision-making process and in reventing complications. In this issue of Digestive and Liver Disease, we have collected hree review articles as a Mini-Symposium focusing on the current nowledge and the open issues regarding MH in IBD. In the first article entitled “Definition and evaluation of mucosal ealing in clinical practice”, Mazzuoli et al. discuss how a precise efinition of mucosal healing has not yet been established and hat the concept of a “complete absence of all inflammatory