Cosimo Prantera - Academia.edu (original) (raw)

Papers by Cosimo Prantera

The Italian journal of gastroenterology

The American Journal of Gastroenterology

ABSTRACT

The Italian journal of gastroenterology

ABSTRACT

The American Journal of Gastroenterology

It is not known whether any link exists between life stress and disease activity in ulcerative co... more It is not known whether any link exists between life stress and disease activity in ulcerative colitis; attempts to demonstrate one have been complicated by recall bias, distressing psychological consequences of disease, psychogenic symptom exaggeration, and an irritable bowel component of inflammatory bowel disease symptoms. We therefore studied the relationship between psychological measures and two different aspects of ulcerative colitis activity. The relation of perceived stress, depression, state anxiety, trait anxiety, and life events with endoscopic appearance of the rectal mucosa was studied "blind" in 46 asymptomatic outpatients with known ulcerative colitis. The same measures were then examined in relation to subjective activity, comparing the group in clinical remission with 32 ulcerative colitis outpatients who reported symptoms. Among asymptomatic patients, the level of stress over the past 2 yr on the General Perceived Stress Questionnaire was higher in the 1...

European journal of epidemiology, 1997

The aim of this study was to analyze the pattern of mortality among patients with ulcerative coli... more The aim of this study was to analyze the pattern of mortality among patients with ulcerative colitis (UC) and compare it with mortality in the general population of the same age and sex. All patients with UC admitted to one of the Inflammatory Bowel Disease Clinics in Rome, from January 1970 to December 31, 1989 were enrolled. Vital status was ascertained through the Registry Office of the last municipality of residence as of July 1, 1990. Cause of death was ascertained through record linkage with the national or regional mortality file and coded using the ninth revision of the International Classification of Diseases. Standardized Mortality Ratios (SMRs) were computed to compare mortality among UC patients with mortality in the general population of the same age and sex. Out of a total of 508 UC patients admitted during the study period, 27 deaths were observed, compared with 27.6 expected (SMR = 98). After excluding prevalent cases, an excess risk of death was observed among newly...

Therapeutic Advances in Gastroenterology, 2013

Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chroni... more Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chronic, uncontrolled inflammation of the gastrointestinal tract. Reported prevalence is high in the United States and northern Europe, while the incidence varies greatly across the rest of Europe. Glucocorticosteroids are the standard treatment for IBD, but due to adverse events their use can be limited. However, new formulations of glucocorticosteroids have been developed to reduce systemic activation. The aim of this review was to assess and summarize the efficacy and safety of new formulations of glucocorticosteroids. A MEDLINE search identified publications focused on new formulations of nonsystemic steroidbased drugs for IBD and benefits and limitations of each of the new glucocorticosteroid formulations were identified. Budesonide has good efficacy and is an established treatment for Crohn's disease; it has been shown to be beneficial for the induction of remission in these patients, although it is not recommended for the maintenance of induced remission. Glucocorticosteroids are not recommended for the maintenance of remission in patients with IBD. However, a recent study suggested that beclomethasone dipropionate may be effective for prolonged treatment in patients in the postacute phase of Crohn's disease who were treated with a short course of systemic steroids. The efficacy of fluticasone propionate and prednisolone metasulphobenzoate in IBD is not well established given the small number of patients enrolled in the few published clinical trials. While the tolerability of these glucocorticosteroids is favourable, more research comparing these new agents with traditional systemic glucocorticosteroids is warranted.

Current Diagnostic Pathology, 2003

ABSTRACT A precise diagnosis of colitis is important for medical and surgical therapy. ‘Indetermi... more ABSTRACT A precise diagnosis of colitis is important for medical and surgical therapy. ‘Indeterminate colitis’ (IC) was originally proposed as a substitute for ‘unclassified colitis’ for patients in whom examination of the surgical specimens showed overlap of pathological features of ulcerative colitis (UC) and Crohn's disease (CD). Nowadays, the term is applied more widely and includes all cases with endoscopic, radiographic and histological evidence of chronic idiopathic inflammatory bowel disease confined to the colon, but without fulfilment of diagnostic criteria for UC or CD. Some authors also include patients for whom the diagnosis changes over time. More than 5% of all patients with idiopathic inflammatory bowel disease are labelled as IC patients. The diagnosis relies upon macroscopy and microscopy. Macroscopic examination is performed by the endoscopist, and the pathologist is responsible for mucosal biopsy samples, so the diagnosis implies clinico-pathological collaboration. In comparison with the original description, microscopic features of the deeper layers of the bowel wall cannot be used in diagnosis when only mucosal biopsies are available. It is generally accepted that IC is a ‘temporary diagnosis’. With time, 50–80% of patients can be reclassified as definite UC or CD, although a minority of cases remain indeterminate for a longer period. These patients are often antineutrophil cytoplasmic antibody and antiSaccharomyces cerevisiae antibody negative. Therefore, some authors have suggested that IC might be a separate entity.

World Journal of Gastroenterology, 2009

5-aminosalicylic acid (5-ASA) compounds are a highly effective treatment for ulcerative colitis (... more 5-aminosalicylic acid (5-ASA) compounds are a highly effective treatment for ulcerative colitis (UC). While UC patient compliance in clinical studies is over 90%, only 40% of patients in every day life take their prescribed therapy. Adherence to medication has been emphasized recently by a Cochrane meta-analysis that has suggested that future trials of 5-ASA in UC should look at patient compliance rather than drug efficacy. Better compliance can be obtained by reducing the number of tablets and times of administration. Given that the 5-ASA formulations have different delivery systems that split the active moiety in various regions of the intestine, it is particularly important that an adequate dose of the drug arrives at the inflamed part of the colon. 5-ASA Multi matrix (MMx) is a novel, high strength (1.2 g), oral formulation designed for oncedaily dosing. It releases the active moiety throughout the colon. Different studies with this compound have shown that it is as effective as 5-ASA enema in the treatment of mild-to-moderate, left-sided UC, and is comparable to a pH-dependent, delayed release 5-ASA (Asacol ® ), even if given once daily. Recently, the effectiveness in the acute phase of UC has been confirmed also in maintenance. In conclusion, at present, 5-ASA MMx seems theoretically the best agent for maintaining patient compliance, and consequently, treatment effectiveness.

The American Journal of Gastroenterology, 2000

We sought to determine whether psychosocial factors influence the course of ulcerative colitis, h... more We sought to determine whether psychosocial factors influence the course of ulcerative colitis, hypothesizing that high perceived stress among patients with inactive disease will increase the risk of subsequent exacerbation.

The American Journal of Gastroenterology, 1998

Ultrasonography is a valid tool in the diagnosis of Crohn's disease, but its sensitivity,... more Ultrasonography is a valid tool in the diagnosis of Crohn's disease, but its sensitivity, specificity, and overall accuracy in the diagnosis of postoperative recurrence are still not well established. The aim of this study was to evaluate the accuracy of ultrasonography compared with endoscopy in the diagnosis of postoperative recurrence of Crohn's disease. Forty-seven patients resected for Crohn's ileitis were studied by ultrasonography and colonoscopy to detect possible recurrence of the disease; 10 patients operated on for cancer of the right colon were used as controls. Six patients with Crohn's disease were excluded from the study because of failure to endoscopically reach the anastomosis; the remaining 41 patients had both ultrasonography and colonoscopy over a period of 14 days. Sonographic recurrence was defined as the presence of >5 mm thickness of the ileal wall. Sensitivity, specificity, and overall accuracy of ultrasonography in diagnosis of postoperative recurrence were 81%, 86%, and 83% respectively. Positive predictive value was 96% and negative predictive value was 57%. This study is the first to assess the role of ultrasonography in comparison with endoscopy in detecting Crohn's disease recurrence after surgery. Our data suggest that ultrasonography should be used first in the case of clinical suspicion of Crohn's disease recurrence, reserving ileocolonoscopy for negative or uncertain cases.

Abbonamenti 2006: istituzionali 100, privati 73 Per la richiesta di abbonamenti e per la richiest... more Abbonamenti 2006: istituzionali 100, privati 73 Per la richiesta di abbonamenti e per la richiesta di inserzioni pubblicitarie rivolgersi a Nuova Editrice Grafica srl, Via Francesco Donati, 180 -00126 Roma Garanzia e riservatezza per gli abbonati L'editore garantisce la massima riservatezza dei dati forniti dagli abbonati e la possibilità di richiederne gratuitamente la rettifica o la cancellazione scrivendo a: Nuova Editrice Grafica srl, Via Francesco Donati, 180 -00126 Roma. Le informazioni custodite nell'archivio elettronico della Nuova Editrice Grafica srl verranno utilizzate al solo scopo di inviare agli abbonati vantaggiose proposte commerciali (legge 675/96). Direttore responsabile: Franco Salvati Iscrizione al registro della Stampa n. 176/98 con ordinanza del Tribunale di Roma in data 6/5/1998 © Copyright Nuova Editrice Grafica srl Finito di stampare nel mese di gennaio 2007 nella tipografia della NUOVA EDITRICE GRAFICA srl -Roma I diritti di traduzione, di riproduzione e di adattamento, totale o parziale, con qualsiasi mezzo (compresi i microfilm e le copie fotostatiche), in lingua italiana, sono riservati per tutti i paesi.

Psychosomatic Medicine, 1998

Journal of Neurology, 2008

Journal of Clinical Gastroenterology, 1991

We assessed the effect of long-lasting inhibition of gastric acid secretion on basal and meal-sti... more We assessed the effect of long-lasting inhibition of gastric acid secretion on basal and meal-stimulated serum gastrin and gastric acid secretion in 37 patients on long-term maintenance treatment with H2 antagonists for severe relapsing and/or complicated duodenal ulcer disease. After a mean of 142 weeks (range, 28-324 weeks) of continuous treatment, gastric acid secretion, basal plasma gastrin, and gastrin response to a test meal were evaluated. All tests were performed a week after drug discontinuation to exclude rapidly reversible hypergastrinemia. Gastrin levels were above the normal range in seven patients (18.9%). After H2 antagonist were stopped for 6 weeks, basal gastrin returned to normal levels in all cases [from a median of 180 (range, 130-350) pg/ml to 58 (25-90) pg/ml] and peak meal-stimulated gastrin significantly decreased from a median of 500 pg/ml to 245 pg/ml (p = 0.02). In patients with hypergastrinemia, the discontinuation of H2 antagonists for 6 weeks led to a significant decrease of gastric acid secretion. Patients who developed hypergastrinemia spent more weeks on full-dose treatment and had more recurrences during therapy. The results of the present investigation demonstrate that a long-lasting inhibition of gastric acid secretion can induce, in a small percentage of patients, a reversible sustained hypergastrinemia and a consequent increase of acid secretion, which conceivably could lead to more frequent relapses of duodenal ulcer disease.

Journal of Clinical Gastroenterology, 1991

The aim of our study was to establish whether plain abdominal film can accurately assess the exte... more The aim of our study was to establish whether plain abdominal film can accurately assess the extent of active ulcerative colitis. Ninety-seven ulcerative colitis patients were studied, in whom the extent of the macroscopic lesion was established either by colonoscopy (n = 75) or by resection (n = 22). Of these, 42 had proctosigmoiditis, 12 left-sided colitis, 12 subtotal colitis, and 31 total colitis. Nine well-tested features were used for the radiological classification of lesion extent. The radiologists were not given any clinical information. Seventy-eight patients (80.4%) were correctly classified by plain abdominal film (r = 0.86); the best concordance was achieved for proctosigmoiditis and total colitis (80.9 and 90.3%, respectively). In total colitis the most reliable radiological features were "irregularity of the mucosal edge" and "increased thickness of the colon wall, " which were present in 74.2 and 67.7%, respectively, of the correctly classified patients. The fourfold combination of these two features with "loss of haustral clefts" and "empty right colon" was present only in patients with total colitis, and at least one of these features was present in all but one of them. Conversely, all nine abnormalities were absent in 73.8% of patients with proctosigmoiditis. In conclusion, plain abdominal film is a reliable tool for judging the extent of lesion in active ulcerative colitis. It seems particularly accurate in total colitis, where, in the acute phases, it is most important to avoid invasive examinations.

Journal of Clinical Gastroenterology, 1988

We estimated the extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patien... more We estimated the extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patients with their first attack of ulcerative colitis. Proctitis was found in 12, proctosigmoiditis in 19, left-sided colitis in 10, and extensive colitis in 19. Fourteen clinical variables and laboratory measurements (bowel frequency, stool consistency, rectal bleeding, fecal mucus/pus, temperature, pulse rate, white blood cell count, hematocrit, sedimentation rate, serum iron, serum albumin, serum alpha 2-globulin, serum C-reactive protein, and seromucoids) were determined. All the variables except rectal bleeding and hematocrit were correlated (p less than 0.001) with the extent of colitis. On stepwise discriminant analysis, only C-reactive protein distinguished proctosigmoiditis from more improved the discrimination. Cross-validation by the "jack-knife method" showed that 86.7% of patients were correctly classified, the errors consisting in underestimation of disease in 8/29 patients with extensive colitis.

Journal of Clinical Gastroenterology, 1994

International Journal of Colorectal Disease, 2001

The introduction of novel anti-tumor necrosis factor (TNF) agents has not only led to impressive ... more The introduction of novel anti-tumor necrosis factor (TNF) agents has not only led to impressive new therapeutic opportunities but also resulted in uncertainty regarding their optimal use and possible side effects. Guidelines are presented here for the use of anti-TNF agents in gastrointestinal disorders. Experts were chosen from different European countries by an algorithm to avoid bias. An expert consensus on guidelines was established using a two-stage procedure of systematic Medline and abstract search for evidence and a qualifying meeting to derive recommendations. Detailed guidelines were developed for the use and the future clinical development of anti-TNF agents in inflammatory bowel disease. Grading of available evidence and grading of recommendations were performed according to AHCPR guidelines. At present infliximab is the only registered agent for Crohn's disease. Infliximab should be always used at a dose of 5 mg/kg. The guidelines define the indications both in refractory and in fistulating disease for the readministration and before surgery. Guidelines for safety and for concomitant treatments are given. Prospects, potential clinical use, and future directions for the clinical development of other anti-TNF agents are detailed. Clinical use of anti-TNF agents will be influenced by a large number of clinical trials being concluded in 2001 and 2002. It is likely that anti-TNF therapies will become an important long-term therapy for a proportion of patients with Crohn's disease. Biological agents will be followed by smaller and more stable, orally available compounds. These guidelines will be succeeded by a formal public consensus in 2002/2003.

Inflammatory Bowel Diseases, 2008

ysis compared with the former one, and the results are not shown.

The Italian journal of gastroenterology

The American Journal of Gastroenterology

ABSTRACT

The Italian journal of gastroenterology

ABSTRACT

The American Journal of Gastroenterology

It is not known whether any link exists between life stress and disease activity in ulcerative co... more It is not known whether any link exists between life stress and disease activity in ulcerative colitis; attempts to demonstrate one have been complicated by recall bias, distressing psychological consequences of disease, psychogenic symptom exaggeration, and an irritable bowel component of inflammatory bowel disease symptoms. We therefore studied the relationship between psychological measures and two different aspects of ulcerative colitis activity. The relation of perceived stress, depression, state anxiety, trait anxiety, and life events with endoscopic appearance of the rectal mucosa was studied "blind" in 46 asymptomatic outpatients with known ulcerative colitis. The same measures were then examined in relation to subjective activity, comparing the group in clinical remission with 32 ulcerative colitis outpatients who reported symptoms. Among asymptomatic patients, the level of stress over the past 2 yr on the General Perceived Stress Questionnaire was higher in the 1...

European journal of epidemiology, 1997

The aim of this study was to analyze the pattern of mortality among patients with ulcerative coli... more The aim of this study was to analyze the pattern of mortality among patients with ulcerative colitis (UC) and compare it with mortality in the general population of the same age and sex. All patients with UC admitted to one of the Inflammatory Bowel Disease Clinics in Rome, from January 1970 to December 31, 1989 were enrolled. Vital status was ascertained through the Registry Office of the last municipality of residence as of July 1, 1990. Cause of death was ascertained through record linkage with the national or regional mortality file and coded using the ninth revision of the International Classification of Diseases. Standardized Mortality Ratios (SMRs) were computed to compare mortality among UC patients with mortality in the general population of the same age and sex. Out of a total of 508 UC patients admitted during the study period, 27 deaths were observed, compared with 27.6 expected (SMR = 98). After excluding prevalent cases, an excess risk of death was observed among newly...

Therapeutic Advances in Gastroenterology, 2013

Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chroni... more Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chronic, uncontrolled inflammation of the gastrointestinal tract. Reported prevalence is high in the United States and northern Europe, while the incidence varies greatly across the rest of Europe. Glucocorticosteroids are the standard treatment for IBD, but due to adverse events their use can be limited. However, new formulations of glucocorticosteroids have been developed to reduce systemic activation. The aim of this review was to assess and summarize the efficacy and safety of new formulations of glucocorticosteroids. A MEDLINE search identified publications focused on new formulations of nonsystemic steroidbased drugs for IBD and benefits and limitations of each of the new glucocorticosteroid formulations were identified. Budesonide has good efficacy and is an established treatment for Crohn's disease; it has been shown to be beneficial for the induction of remission in these patients, although it is not recommended for the maintenance of induced remission. Glucocorticosteroids are not recommended for the maintenance of remission in patients with IBD. However, a recent study suggested that beclomethasone dipropionate may be effective for prolonged treatment in patients in the postacute phase of Crohn's disease who were treated with a short course of systemic steroids. The efficacy of fluticasone propionate and prednisolone metasulphobenzoate in IBD is not well established given the small number of patients enrolled in the few published clinical trials. While the tolerability of these glucocorticosteroids is favourable, more research comparing these new agents with traditional systemic glucocorticosteroids is warranted.

Current Diagnostic Pathology, 2003

ABSTRACT A precise diagnosis of colitis is important for medical and surgical therapy. ‘Indetermi... more ABSTRACT A precise diagnosis of colitis is important for medical and surgical therapy. ‘Indeterminate colitis’ (IC) was originally proposed as a substitute for ‘unclassified colitis’ for patients in whom examination of the surgical specimens showed overlap of pathological features of ulcerative colitis (UC) and Crohn's disease (CD). Nowadays, the term is applied more widely and includes all cases with endoscopic, radiographic and histological evidence of chronic idiopathic inflammatory bowel disease confined to the colon, but without fulfilment of diagnostic criteria for UC or CD. Some authors also include patients for whom the diagnosis changes over time. More than 5% of all patients with idiopathic inflammatory bowel disease are labelled as IC patients. The diagnosis relies upon macroscopy and microscopy. Macroscopic examination is performed by the endoscopist, and the pathologist is responsible for mucosal biopsy samples, so the diagnosis implies clinico-pathological collaboration. In comparison with the original description, microscopic features of the deeper layers of the bowel wall cannot be used in diagnosis when only mucosal biopsies are available. It is generally accepted that IC is a ‘temporary diagnosis’. With time, 50–80% of patients can be reclassified as definite UC or CD, although a minority of cases remain indeterminate for a longer period. These patients are often antineutrophil cytoplasmic antibody and antiSaccharomyces cerevisiae antibody negative. Therefore, some authors have suggested that IC might be a separate entity.

World Journal of Gastroenterology, 2009

5-aminosalicylic acid (5-ASA) compounds are a highly effective treatment for ulcerative colitis (... more 5-aminosalicylic acid (5-ASA) compounds are a highly effective treatment for ulcerative colitis (UC). While UC patient compliance in clinical studies is over 90%, only 40% of patients in every day life take their prescribed therapy. Adherence to medication has been emphasized recently by a Cochrane meta-analysis that has suggested that future trials of 5-ASA in UC should look at patient compliance rather than drug efficacy. Better compliance can be obtained by reducing the number of tablets and times of administration. Given that the 5-ASA formulations have different delivery systems that split the active moiety in various regions of the intestine, it is particularly important that an adequate dose of the drug arrives at the inflamed part of the colon. 5-ASA Multi matrix (MMx) is a novel, high strength (1.2 g), oral formulation designed for oncedaily dosing. It releases the active moiety throughout the colon. Different studies with this compound have shown that it is as effective as 5-ASA enema in the treatment of mild-to-moderate, left-sided UC, and is comparable to a pH-dependent, delayed release 5-ASA (Asacol ® ), even if given once daily. Recently, the effectiveness in the acute phase of UC has been confirmed also in maintenance. In conclusion, at present, 5-ASA MMx seems theoretically the best agent for maintaining patient compliance, and consequently, treatment effectiveness.

The American Journal of Gastroenterology, 2000

We sought to determine whether psychosocial factors influence the course of ulcerative colitis, h... more We sought to determine whether psychosocial factors influence the course of ulcerative colitis, hypothesizing that high perceived stress among patients with inactive disease will increase the risk of subsequent exacerbation.

The American Journal of Gastroenterology, 1998

Ultrasonography is a valid tool in the diagnosis of Crohn's disease, but its sensitivity,... more Ultrasonography is a valid tool in the diagnosis of Crohn's disease, but its sensitivity, specificity, and overall accuracy in the diagnosis of postoperative recurrence are still not well established. The aim of this study was to evaluate the accuracy of ultrasonography compared with endoscopy in the diagnosis of postoperative recurrence of Crohn's disease. Forty-seven patients resected for Crohn's ileitis were studied by ultrasonography and colonoscopy to detect possible recurrence of the disease; 10 patients operated on for cancer of the right colon were used as controls. Six patients with Crohn's disease were excluded from the study because of failure to endoscopically reach the anastomosis; the remaining 41 patients had both ultrasonography and colonoscopy over a period of 14 days. Sonographic recurrence was defined as the presence of >5 mm thickness of the ileal wall. Sensitivity, specificity, and overall accuracy of ultrasonography in diagnosis of postoperative recurrence were 81%, 86%, and 83% respectively. Positive predictive value was 96% and negative predictive value was 57%. This study is the first to assess the role of ultrasonography in comparison with endoscopy in detecting Crohn's disease recurrence after surgery. Our data suggest that ultrasonography should be used first in the case of clinical suspicion of Crohn's disease recurrence, reserving ileocolonoscopy for negative or uncertain cases.

Abbonamenti 2006: istituzionali 100, privati 73 Per la richiesta di abbonamenti e per la richiest... more Abbonamenti 2006: istituzionali 100, privati 73 Per la richiesta di abbonamenti e per la richiesta di inserzioni pubblicitarie rivolgersi a Nuova Editrice Grafica srl, Via Francesco Donati, 180 -00126 Roma Garanzia e riservatezza per gli abbonati L'editore garantisce la massima riservatezza dei dati forniti dagli abbonati e la possibilità di richiederne gratuitamente la rettifica o la cancellazione scrivendo a: Nuova Editrice Grafica srl, Via Francesco Donati, 180 -00126 Roma. Le informazioni custodite nell'archivio elettronico della Nuova Editrice Grafica srl verranno utilizzate al solo scopo di inviare agli abbonati vantaggiose proposte commerciali (legge 675/96). Direttore responsabile: Franco Salvati Iscrizione al registro della Stampa n. 176/98 con ordinanza del Tribunale di Roma in data 6/5/1998 © Copyright Nuova Editrice Grafica srl Finito di stampare nel mese di gennaio 2007 nella tipografia della NUOVA EDITRICE GRAFICA srl -Roma I diritti di traduzione, di riproduzione e di adattamento, totale o parziale, con qualsiasi mezzo (compresi i microfilm e le copie fotostatiche), in lingua italiana, sono riservati per tutti i paesi.

Psychosomatic Medicine, 1998

Journal of Neurology, 2008

Journal of Clinical Gastroenterology, 1991

We assessed the effect of long-lasting inhibition of gastric acid secretion on basal and meal-sti... more We assessed the effect of long-lasting inhibition of gastric acid secretion on basal and meal-stimulated serum gastrin and gastric acid secretion in 37 patients on long-term maintenance treatment with H2 antagonists for severe relapsing and/or complicated duodenal ulcer disease. After a mean of 142 weeks (range, 28-324 weeks) of continuous treatment, gastric acid secretion, basal plasma gastrin, and gastrin response to a test meal were evaluated. All tests were performed a week after drug discontinuation to exclude rapidly reversible hypergastrinemia. Gastrin levels were above the normal range in seven patients (18.9%). After H2 antagonist were stopped for 6 weeks, basal gastrin returned to normal levels in all cases [from a median of 180 (range, 130-350) pg/ml to 58 (25-90) pg/ml] and peak meal-stimulated gastrin significantly decreased from a median of 500 pg/ml to 245 pg/ml (p = 0.02). In patients with hypergastrinemia, the discontinuation of H2 antagonists for 6 weeks led to a significant decrease of gastric acid secretion. Patients who developed hypergastrinemia spent more weeks on full-dose treatment and had more recurrences during therapy. The results of the present investigation demonstrate that a long-lasting inhibition of gastric acid secretion can induce, in a small percentage of patients, a reversible sustained hypergastrinemia and a consequent increase of acid secretion, which conceivably could lead to more frequent relapses of duodenal ulcer disease.

Journal of Clinical Gastroenterology, 1991

The aim of our study was to establish whether plain abdominal film can accurately assess the exte... more The aim of our study was to establish whether plain abdominal film can accurately assess the extent of active ulcerative colitis. Ninety-seven ulcerative colitis patients were studied, in whom the extent of the macroscopic lesion was established either by colonoscopy (n = 75) or by resection (n = 22). Of these, 42 had proctosigmoiditis, 12 left-sided colitis, 12 subtotal colitis, and 31 total colitis. Nine well-tested features were used for the radiological classification of lesion extent. The radiologists were not given any clinical information. Seventy-eight patients (80.4%) were correctly classified by plain abdominal film (r = 0.86); the best concordance was achieved for proctosigmoiditis and total colitis (80.9 and 90.3%, respectively). In total colitis the most reliable radiological features were "irregularity of the mucosal edge" and "increased thickness of the colon wall, " which were present in 74.2 and 67.7%, respectively, of the correctly classified patients. The fourfold combination of these two features with "loss of haustral clefts" and "empty right colon" was present only in patients with total colitis, and at least one of these features was present in all but one of them. Conversely, all nine abnormalities were absent in 73.8% of patients with proctosigmoiditis. In conclusion, plain abdominal film is a reliable tool for judging the extent of lesion in active ulcerative colitis. It seems particularly accurate in total colitis, where, in the acute phases, it is most important to avoid invasive examinations.

Journal of Clinical Gastroenterology, 1988

We estimated the extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patien... more We estimated the extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patients with their first attack of ulcerative colitis. Proctitis was found in 12, proctosigmoiditis in 19, left-sided colitis in 10, and extensive colitis in 19. Fourteen clinical variables and laboratory measurements (bowel frequency, stool consistency, rectal bleeding, fecal mucus/pus, temperature, pulse rate, white blood cell count, hematocrit, sedimentation rate, serum iron, serum albumin, serum alpha 2-globulin, serum C-reactive protein, and seromucoids) were determined. All the variables except rectal bleeding and hematocrit were correlated (p less than 0.001) with the extent of colitis. On stepwise discriminant analysis, only C-reactive protein distinguished proctosigmoiditis from more improved the discrimination. Cross-validation by the "jack-knife method" showed that 86.7% of patients were correctly classified, the errors consisting in underestimation of disease in 8/29 patients with extensive colitis.

Journal of Clinical Gastroenterology, 1994

International Journal of Colorectal Disease, 2001

The introduction of novel anti-tumor necrosis factor (TNF) agents has not only led to impressive ... more The introduction of novel anti-tumor necrosis factor (TNF) agents has not only led to impressive new therapeutic opportunities but also resulted in uncertainty regarding their optimal use and possible side effects. Guidelines are presented here for the use of anti-TNF agents in gastrointestinal disorders. Experts were chosen from different European countries by an algorithm to avoid bias. An expert consensus on guidelines was established using a two-stage procedure of systematic Medline and abstract search for evidence and a qualifying meeting to derive recommendations. Detailed guidelines were developed for the use and the future clinical development of anti-TNF agents in inflammatory bowel disease. Grading of available evidence and grading of recommendations were performed according to AHCPR guidelines. At present infliximab is the only registered agent for Crohn's disease. Infliximab should be always used at a dose of 5 mg/kg. The guidelines define the indications both in refractory and in fistulating disease for the readministration and before surgery. Guidelines for safety and for concomitant treatments are given. Prospects, potential clinical use, and future directions for the clinical development of other anti-TNF agents are detailed. Clinical use of anti-TNF agents will be influenced by a large number of clinical trials being concluded in 2001 and 2002. It is likely that anti-TNF therapies will become an important long-term therapy for a proportion of patients with Crohn's disease. Biological agents will be followed by smaller and more stable, orally available compounds. These guidelines will be succeeded by a formal public consensus in 2002/2003.

Inflammatory Bowel Diseases, 2008

ysis compared with the former one, and the results are not shown.