G. Maconi - Academia.edu (original) (raw)
Papers by G. Maconi
Digestive and Liver Disease
Digestive and Liver Disease
Digestive and Liver Disease
Digestive and Liver Disease
Journal of Crohn's and Colitis Supplements, 2007
Poster Presentations different 5-ASA (Pentasa ®) dosages (2 gr/day followed by 4 gr/day) on thiop... more Poster Presentations different 5-ASA (Pentasa ®) dosages (2 gr/day followed by 4 gr/day) on thiopurine metabolism. IBD patients on monotherapy thiopurines were included and received consecutively the 2 different 5-ASA regimes. 6-Thioguaninenucleotide (6-TGN), 6-methylmercaptopurine (6-MMP), 5-ASA and N-acetyl-5-aminosalicylic acid (N-5-ASA) levels were determined before 5-ASA therapy (t=1), after 4 weeks of 2 gr/day (t=2), after 4 weeks of 4 gr/day (t=3) and after at least 4 weeks after cessation of 5-ASA therapy (t=4). In addition, routine laboratory parameters were determined. Results: Twenty-six IBD patients (42% male and 69% CD) on steady state thiopurine monotherapy were included. Mean 6-TGN levels during the different regimes were 243 (t=1), 326 (t=2), 396 (t=3) and 286 (t=4) pmol/8×10 8 RBC, respectively. Mean 6-MMP levels were 3023 (t=1), 3516 (t=2), 2896 (t=3) and 2899 (t=4) pmol/8×10 8 RBC, respectively. Mean 5-ASA levels were 0 (t=1), 1055 (t=2), 2422 (t=3) and 0 (t=4) ng/ml serum. Mean N-5-ASA levels were 0 (t=1), 2287 (t=2), 3822 (t=3) and 0 (t=4) ng/ml serum. A rise in 6-TGN level following 5-ASA comedication was observed in 92% (t=2) and 100% (t=3) of patients. Individual 6-TGN levels increased statistically significant with 45% (t=2) and 70% (t=3), respectively. No statistically significant variations in 6-MMP levels were observed. No correlations were established between 5-ASA and thiopurine metabolites. Two patients (8%) developed a leucopenia (2.4×10 9 /l) that resolved spontaneously. Conclusion: This pharmacokinetic study shows that 6-TGN levels increase in a dose-dependent manner during 5-ASA co-administration. However, 5-ASA has no influence on 6-MMP levels which reflect TPMT activity. Our results warrant further studies on 5-ASA use in IBD patients who develop inadequate 6-TGN levels during thiopurine therapy as well as to the pharmacodynamics
Progress in Basic and Clinical Pharmacology, 1999
Journal of Crohn's and Colitis Supplements, 2008
Journal of Crohn's and Colitis Supplements, 2007
Minerva gastroenterologica e dietologica, 2011
The standard therapeutic approach for symptomatic uncomplicated diverticular disease (DD) remains... more The standard therapeutic approach for symptomatic uncomplicated diverticular disease (DD) remains to be defined, and only a few studies have tested the efficacy of probiotics in these patients. Patients with symptomatic uncomplicated DD were randomized to a control arm, i.e., (group A, [N.=16], high-fibre diet alone), or to Group B ([n=18], twice daily 1 sachet of probiotic + high-fibre diet), or group C ([N.=16], twice daily 2 sachets of probiotic + high-fibre diet). The probiotic Genefilus F19© containing Lactobacillus paracasei sub. paracasei F19 was administered for 14 days/month for 6 months. The primary endpoint under consideration was a decrease in abdominal pain and bloating intensity after treatment. Bloating decreased significantly in Groups B and C VAS score group B: 4.6 ± 2.6 vs. 2.3 ± 2.0, P<0.05, group C: 3.9 ± 2.9 vs. 1.8 ± 2.1, P<0.05). The decrease in abdominal pain within 24 hours in these groups did not reach statistical significance. During treatment, none ...
Annali italiani di chirurgia
The use of ultrasound in Crohns disease has a recent history. This method is useful in various si... more The use of ultrasound in Crohns disease has a recent history. This method is useful in various situations like: the diagnosis of the disease, the diagnosis of intra-abdominal complications and the follow-up of the operated patient. Moreover, thanks to its practicality of use, ripetibility and accuracy, ultrasounds can represent a first line diagnostic instrument for Crohns disease both in elective and emergency conditions. The authors, in this paper, consider its usefulness and various aspects in these conditions.
Annali italiani di chirurgia
About 40% of patients with Crohns disease (CD) have a perianal involvement. Despite the recent in... more About 40% of patients with Crohns disease (CD) have a perianal involvement. Despite the recent introduction of anti-TNF antibody, this therapy has uncertain long-term results and surgery still remains a major treatment option. This study relates our experience in surgical management of perianal CD without anti-TNF treatment. From July 92 to February 02, 37 patients with perianal Crohns disease were treated, 43 underwent local operations or faecal diversion for fistulas and/or abscesses. Patients not requiring surgery or in therapy with anti-TNF. were excluded from the study. We analysed the outcome of surgical treatment for perianal CD. Male to female ratio was 1:0.6, median age was 36,9 years (range 17-62). Perianal disease included 32 fistulas (16 trans-sphincteric, 2 superficial, 2 ano-vaginal, 10 multiple and complex, 2 horseshoe) and 7 abscesses (5 perianal, 2 ischio-rectal). Local surgery included 1 abscess drainage, 5 abscess drainage and fistula incision with seton insertion...
The American journal of gastroenterology, 2001
This study aimed to evaluate the influence of environmental and sociodemographic factors and the ... more This study aimed to evaluate the influence of environmental and sociodemographic factors and the effect of smoking, alcohol, and dietary habits on the risk of gastric intestinal metaplasia (IM) in Helicobacter pylori-infected subjects. The investigation was based on 2598 consecutive volunteer blood donors tested for the presence of antibodies against H. pylori from March 1995 to March 1997. Endoscopy with multiple biopsies was offered to all H. pylori-positive, symptomatic subjects. The presence or absence of IM was diagnosed by gastric biopsies. A serologically H. pylori-positive subject with gastric IM was defined as a case, whereas serologically H. pylori-positive subjects without IM were used as controls. All patients answered a detailed questionnaire collecting sociodemographic characteristics and smoking, alcohol drinking, and dietary habits. Odds ratios (ORs) and their 95% CIs were estimated by unconditional logistic regression, including terms for age and sex, to assess the ...
The American journal of gastroenterology, 1998
To date, little is known about a possible relationship between H. pylori-related disturbances of ... more To date, little is known about a possible relationship between H. pylori-related disturbances of gastric function and the bacterial virulence. The aim of this study was to assess whether certain gastric function indices as well as the pattern of symptoms in nonulcer dyspepsia (NUD) are related to CagA status. A total of 56 consecutive patients with NUD (38 H. pylori-positive and 18 H. pylori-negative) were studied. Dyspeptic symptoms were categorized according to the predominant complaints and scored for severity and frequency. In all subjects, basal and pentagastrin-stimulated acid secretion, fasting and meal-induced gastrin release, fasting serum pepsinogen I (PG I) levels, and gastric emptying of solids were determined. CagA status was determined by assaying serum CagA IgG antibodies by western blotting. Eighteen of 38 (47%) H. pylori-positive dyspeptics were CagA seropositive. Type and severity of dyspeptic symptoms did not significantly differ between CagA-positive and CagA-neg...
Journal of gastrointestinal and liver diseases : JGLD, 2010
Different symptoms have been attributed to uncomplicated diverticular disease (DD). Poor absorbab... more Different symptoms have been attributed to uncomplicated diverticular disease (DD). Poor absorbable antibiotics are largely used for uncomplicated DD, mainly for symptom treatment and prevention of diverticulitis onset. Controlled trials on cyclic administration of rifaximin in DD patients were evaluated. Four controlled, including 1 double-blind and 3 open-label, randomized studies were available. Following a long-term cyclic therapy, a significant difference emerged in the global symptoms score (range: 0-18) between rifaximin plus fibers (from 6-6.5 to 1-2) and fibers alone (from 6.7 to 2-3.8), although the actual clinically relevance of such a very small difference remains to be ascertained. Moreover, a similar global symptom score reduction (from 6 to 2.4) can be achieved by simply recommending an inexpensive high-fiber diet. Current data suggest that cyclic rifaximin plus fibers significantly reduce the incidence of the first episode of acute diverticulitis as compared to fiber...
United European gastroenterology journal, 2014
The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (G... more The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease (DD) in patients with uncomplicated and complicated DD were reviewed by a scientific board of experts who proposed 55 statements graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. Comparison and discussion of expert opinions, pertinent statements and replies to specific questions, were presented and approved based on a systematic literature search of the available evidence. Comments were added explaining the basis for grading the evidence, particularly for controversial areas.
Journal of Crohn's and Colitis Supplements, 2007
Background and Aim: The loss tolerance is a key point for the pathogenesis of inflammatory bowel ... more Background and Aim: The loss tolerance is a key point for the pathogenesis of inflammatory bowel disease (IBD). Dendritic cells (DC) are thought to be involved in maintenance of oral tolerance depending on their location, number and maturation state. Recently, published data showed that: a) patients with active Crohn' s disease lack of immature, possibly tolerogenic, blood plasmacytoid (P) and myeloid (M) DC; b) blood DCs express gut homing marker and migrate in gut tissue where they activate systemic and tissue immune response (increase levels of IL-12, IL-6 and TNF-alpha). Chimeric monoclonal anti-TNFα antibody infliximab represent the most important advances in the past decade in the care of moderate-to-severe IBD patients but up to date no knowledge are available on the influence of such biologic treatment on DC. Aim of this study has been to study number and subsets distribution of blood DC during infliximab treatment. Material and Methods: Peripheral blood was obtained from 6 pts, (5F, 1M) affected by active IBD with a long history of illness (median 9 yrs). 4/6 pts suffered from Crohn' s disease and the other 2 pts from Ulcerative Colitis. Extraintestinal manifestations were arthralgia in 2/4 and pyoderma gangrenosum in the other 2 pts with CD. All ptz with a disease activity score of at least 220 (CDAI) for CD and 9 (DAI) for UC resulted refractory to traditional therapy (corticosteroids and immunomodulators) and started Infliximab (5mg/kg/ev) at 0, 2, 6 and 14 week. At every predefined infusion clinical activity (CDAI/DAI, IBDQ), steroid tapering and peripheral DC enumeration was performed by a multi color flow cytometric analysis (Partec PAS). PDC and MDC1 and MDC2 were detected by staining with anti-BDCA-2-FITC, CD1(anti-BDCA-1)-PE and anti-BDCA-3-APC, respectively. Monocytes and B cells were excluded from the analysis using anti-CD14 and anti-CD19 PE-Cy5conjugated mAb. Fluorochrome-conjugated species-and isotype-matched irrelevant mAb were used as negative controls. Results: All 6 pts, at forth Infliximab administration showed a good clinical response with a CDAI at least 70 points less than the week 0 for CD pts and DAI <7 points for UC pts, IBDQ was >200 for all of them. Correspondently, flow analysis showed a significant increased of all blood DC subsets over infliximab treatment as respect to baseline (BDCA-1+: 7203±1476 vs 2737±1017 cells/ml; BDCA-2+: 9616±3037 vs 3510±2260 cells/ml; BDCA-3+: 54±25 vs 3±1 cells/ml). No differences were detected between UC and CD pts. Conclusion: These findings suggest that clinical improvement of IBD pts after Infliximab treatment might happen also through DC modification, since their number increases over treatment in peripheral blood. Reduction of proinflammatory cytokine in gut tissue could reduce DC intestinal homing and explain their rise in number in peripheral blood. Further studies would be suitable to confirm these data.
Digestive and Liver Disease
Digestive and Liver Disease
Digestive and Liver Disease
Digestive and Liver Disease
Journal of Crohn's and Colitis Supplements, 2007
Poster Presentations different 5-ASA (Pentasa ®) dosages (2 gr/day followed by 4 gr/day) on thiop... more Poster Presentations different 5-ASA (Pentasa ®) dosages (2 gr/day followed by 4 gr/day) on thiopurine metabolism. IBD patients on monotherapy thiopurines were included and received consecutively the 2 different 5-ASA regimes. 6-Thioguaninenucleotide (6-TGN), 6-methylmercaptopurine (6-MMP), 5-ASA and N-acetyl-5-aminosalicylic acid (N-5-ASA) levels were determined before 5-ASA therapy (t=1), after 4 weeks of 2 gr/day (t=2), after 4 weeks of 4 gr/day (t=3) and after at least 4 weeks after cessation of 5-ASA therapy (t=4). In addition, routine laboratory parameters were determined. Results: Twenty-six IBD patients (42% male and 69% CD) on steady state thiopurine monotherapy were included. Mean 6-TGN levels during the different regimes were 243 (t=1), 326 (t=2), 396 (t=3) and 286 (t=4) pmol/8×10 8 RBC, respectively. Mean 6-MMP levels were 3023 (t=1), 3516 (t=2), 2896 (t=3) and 2899 (t=4) pmol/8×10 8 RBC, respectively. Mean 5-ASA levels were 0 (t=1), 1055 (t=2), 2422 (t=3) and 0 (t=4) ng/ml serum. Mean N-5-ASA levels were 0 (t=1), 2287 (t=2), 3822 (t=3) and 0 (t=4) ng/ml serum. A rise in 6-TGN level following 5-ASA comedication was observed in 92% (t=2) and 100% (t=3) of patients. Individual 6-TGN levels increased statistically significant with 45% (t=2) and 70% (t=3), respectively. No statistically significant variations in 6-MMP levels were observed. No correlations were established between 5-ASA and thiopurine metabolites. Two patients (8%) developed a leucopenia (2.4×10 9 /l) that resolved spontaneously. Conclusion: This pharmacokinetic study shows that 6-TGN levels increase in a dose-dependent manner during 5-ASA co-administration. However, 5-ASA has no influence on 6-MMP levels which reflect TPMT activity. Our results warrant further studies on 5-ASA use in IBD patients who develop inadequate 6-TGN levels during thiopurine therapy as well as to the pharmacodynamics
Progress in Basic and Clinical Pharmacology, 1999
Journal of Crohn's and Colitis Supplements, 2008
Journal of Crohn's and Colitis Supplements, 2007
Minerva gastroenterologica e dietologica, 2011
The standard therapeutic approach for symptomatic uncomplicated diverticular disease (DD) remains... more The standard therapeutic approach for symptomatic uncomplicated diverticular disease (DD) remains to be defined, and only a few studies have tested the efficacy of probiotics in these patients. Patients with symptomatic uncomplicated DD were randomized to a control arm, i.e., (group A, [N.=16], high-fibre diet alone), or to Group B ([n=18], twice daily 1 sachet of probiotic + high-fibre diet), or group C ([N.=16], twice daily 2 sachets of probiotic + high-fibre diet). The probiotic Genefilus F19© containing Lactobacillus paracasei sub. paracasei F19 was administered for 14 days/month for 6 months. The primary endpoint under consideration was a decrease in abdominal pain and bloating intensity after treatment. Bloating decreased significantly in Groups B and C VAS score group B: 4.6 ± 2.6 vs. 2.3 ± 2.0, P<0.05, group C: 3.9 ± 2.9 vs. 1.8 ± 2.1, P<0.05). The decrease in abdominal pain within 24 hours in these groups did not reach statistical significance. During treatment, none ...
Annali italiani di chirurgia
The use of ultrasound in Crohns disease has a recent history. This method is useful in various si... more The use of ultrasound in Crohns disease has a recent history. This method is useful in various situations like: the diagnosis of the disease, the diagnosis of intra-abdominal complications and the follow-up of the operated patient. Moreover, thanks to its practicality of use, ripetibility and accuracy, ultrasounds can represent a first line diagnostic instrument for Crohns disease both in elective and emergency conditions. The authors, in this paper, consider its usefulness and various aspects in these conditions.
Annali italiani di chirurgia
About 40% of patients with Crohns disease (CD) have a perianal involvement. Despite the recent in... more About 40% of patients with Crohns disease (CD) have a perianal involvement. Despite the recent introduction of anti-TNF antibody, this therapy has uncertain long-term results and surgery still remains a major treatment option. This study relates our experience in surgical management of perianal CD without anti-TNF treatment. From July 92 to February 02, 37 patients with perianal Crohns disease were treated, 43 underwent local operations or faecal diversion for fistulas and/or abscesses. Patients not requiring surgery or in therapy with anti-TNF. were excluded from the study. We analysed the outcome of surgical treatment for perianal CD. Male to female ratio was 1:0.6, median age was 36,9 years (range 17-62). Perianal disease included 32 fistulas (16 trans-sphincteric, 2 superficial, 2 ano-vaginal, 10 multiple and complex, 2 horseshoe) and 7 abscesses (5 perianal, 2 ischio-rectal). Local surgery included 1 abscess drainage, 5 abscess drainage and fistula incision with seton insertion...
The American journal of gastroenterology, 2001
This study aimed to evaluate the influence of environmental and sociodemographic factors and the ... more This study aimed to evaluate the influence of environmental and sociodemographic factors and the effect of smoking, alcohol, and dietary habits on the risk of gastric intestinal metaplasia (IM) in Helicobacter pylori-infected subjects. The investigation was based on 2598 consecutive volunteer blood donors tested for the presence of antibodies against H. pylori from March 1995 to March 1997. Endoscopy with multiple biopsies was offered to all H. pylori-positive, symptomatic subjects. The presence or absence of IM was diagnosed by gastric biopsies. A serologically H. pylori-positive subject with gastric IM was defined as a case, whereas serologically H. pylori-positive subjects without IM were used as controls. All patients answered a detailed questionnaire collecting sociodemographic characteristics and smoking, alcohol drinking, and dietary habits. Odds ratios (ORs) and their 95% CIs were estimated by unconditional logistic regression, including terms for age and sex, to assess the ...
The American journal of gastroenterology, 1998
To date, little is known about a possible relationship between H. pylori-related disturbances of ... more To date, little is known about a possible relationship between H. pylori-related disturbances of gastric function and the bacterial virulence. The aim of this study was to assess whether certain gastric function indices as well as the pattern of symptoms in nonulcer dyspepsia (NUD) are related to CagA status. A total of 56 consecutive patients with NUD (38 H. pylori-positive and 18 H. pylori-negative) were studied. Dyspeptic symptoms were categorized according to the predominant complaints and scored for severity and frequency. In all subjects, basal and pentagastrin-stimulated acid secretion, fasting and meal-induced gastrin release, fasting serum pepsinogen I (PG I) levels, and gastric emptying of solids were determined. CagA status was determined by assaying serum CagA IgG antibodies by western blotting. Eighteen of 38 (47%) H. pylori-positive dyspeptics were CagA seropositive. Type and severity of dyspeptic symptoms did not significantly differ between CagA-positive and CagA-neg...
Journal of gastrointestinal and liver diseases : JGLD, 2010
Different symptoms have been attributed to uncomplicated diverticular disease (DD). Poor absorbab... more Different symptoms have been attributed to uncomplicated diverticular disease (DD). Poor absorbable antibiotics are largely used for uncomplicated DD, mainly for symptom treatment and prevention of diverticulitis onset. Controlled trials on cyclic administration of rifaximin in DD patients were evaluated. Four controlled, including 1 double-blind and 3 open-label, randomized studies were available. Following a long-term cyclic therapy, a significant difference emerged in the global symptoms score (range: 0-18) between rifaximin plus fibers (from 6-6.5 to 1-2) and fibers alone (from 6.7 to 2-3.8), although the actual clinically relevance of such a very small difference remains to be ascertained. Moreover, a similar global symptom score reduction (from 6 to 2.4) can be achieved by simply recommending an inexpensive high-fiber diet. Current data suggest that cyclic rifaximin plus fibers significantly reduce the incidence of the first episode of acute diverticulitis as compared to fiber...
United European gastroenterology journal, 2014
The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (G... more The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease (DD) in patients with uncomplicated and complicated DD were reviewed by a scientific board of experts who proposed 55 statements graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. Comparison and discussion of expert opinions, pertinent statements and replies to specific questions, were presented and approved based on a systematic literature search of the available evidence. Comments were added explaining the basis for grading the evidence, particularly for controversial areas.
Journal of Crohn's and Colitis Supplements, 2007
Background and Aim: The loss tolerance is a key point for the pathogenesis of inflammatory bowel ... more Background and Aim: The loss tolerance is a key point for the pathogenesis of inflammatory bowel disease (IBD). Dendritic cells (DC) are thought to be involved in maintenance of oral tolerance depending on their location, number and maturation state. Recently, published data showed that: a) patients with active Crohn' s disease lack of immature, possibly tolerogenic, blood plasmacytoid (P) and myeloid (M) DC; b) blood DCs express gut homing marker and migrate in gut tissue where they activate systemic and tissue immune response (increase levels of IL-12, IL-6 and TNF-alpha). Chimeric monoclonal anti-TNFα antibody infliximab represent the most important advances in the past decade in the care of moderate-to-severe IBD patients but up to date no knowledge are available on the influence of such biologic treatment on DC. Aim of this study has been to study number and subsets distribution of blood DC during infliximab treatment. Material and Methods: Peripheral blood was obtained from 6 pts, (5F, 1M) affected by active IBD with a long history of illness (median 9 yrs). 4/6 pts suffered from Crohn' s disease and the other 2 pts from Ulcerative Colitis. Extraintestinal manifestations were arthralgia in 2/4 and pyoderma gangrenosum in the other 2 pts with CD. All ptz with a disease activity score of at least 220 (CDAI) for CD and 9 (DAI) for UC resulted refractory to traditional therapy (corticosteroids and immunomodulators) and started Infliximab (5mg/kg/ev) at 0, 2, 6 and 14 week. At every predefined infusion clinical activity (CDAI/DAI, IBDQ), steroid tapering and peripheral DC enumeration was performed by a multi color flow cytometric analysis (Partec PAS). PDC and MDC1 and MDC2 were detected by staining with anti-BDCA-2-FITC, CD1(anti-BDCA-1)-PE and anti-BDCA-3-APC, respectively. Monocytes and B cells were excluded from the analysis using anti-CD14 and anti-CD19 PE-Cy5conjugated mAb. Fluorochrome-conjugated species-and isotype-matched irrelevant mAb were used as negative controls. Results: All 6 pts, at forth Infliximab administration showed a good clinical response with a CDAI at least 70 points less than the week 0 for CD pts and DAI <7 points for UC pts, IBDQ was >200 for all of them. Correspondently, flow analysis showed a significant increased of all blood DC subsets over infliximab treatment as respect to baseline (BDCA-1+: 7203±1476 vs 2737±1017 cells/ml; BDCA-2+: 9616±3037 vs 3510±2260 cells/ml; BDCA-3+: 54±25 vs 3±1 cells/ml). No differences were detected between UC and CD pts. Conclusion: These findings suggest that clinical improvement of IBD pts after Infliximab treatment might happen also through DC modification, since their number increases over treatment in peripheral blood. Reduction of proinflammatory cytokine in gut tissue could reduce DC intestinal homing and explain their rise in number in peripheral blood. Further studies would be suitable to confirm these data.