Ioanna Parisi - Academia.edu (original) (raw)

Papers by Ioanna Parisi

Research paper thumbnail of P445 Does The Sequence Matter ? Comparative effectiveness of a second line biologic in patients with Ulcerative Colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab

Journal of Crohn's and Colitis, 2021

Background Drug choice and order in Inflammatory Bowel Disease (IBD) is an important challenge an... more Background Drug choice and order in Inflammatory Bowel Disease (IBD) is an important challenge and is becoming increasingly complex. There are few studies comparing head-to-head outcomes in second line treatments in Ulcerative Colitis (UC). It is unclear if using anti-Tumour Necrosis Factor-a (anti-TNF) therapy following vedolizumab (VDZ) or VDZ after anti-TNF has a more favourable outcome in UC in a real-world outpatient setting. Methods Patients with UC who were exposed to first-line anti-TNF (adalimumab/ADA or infliximab/IFX) or VDZ who subsequently switched to the alternate class between May 2013-August 2020 were identified following a review of databases at 10 hospitals. 88 VDZ and 39 anti-TNF (12 ADA,27 IFX) second line patients were eligible. Data was collected retrospectively. Baseline demographics, disease activity indices, colectomy rates, treatment persistence and healthcare resource utilisation composite endpoint (HRUC) were examined over a 52 week period for the second ...

Research paper thumbnail of P592 Efficacy of vedolizumab for induction and maintenance of clinical remission in ulcerative colitis: The UCLH experience

Journal of Crohn's and Colitis, 2018

Background: There is limited utilisation of gastrointestinal ultrasonography (GIUS) in inflammato... more Background: There is limited utilisation of gastrointestinal ultrasonography (GIUS) in inflammatory bowel disease (IBD) by clinicians around the world. This study evaluated the benefits of IUS in IBD management from the patient's perspective and the value of GIUS in clinical decision-making. Methods: This was an observational, non-interventional cohort study investigating the real-world clinical management of patients (≥18 years of age) diagnosed with IBD. During routine outpatient consultations, patients were allocated to receive GIUS or not according to their clinical requirements. Patients completed self-reported questionnaires at study entry, immediately after their consultation and then at 4 and 16 weeks post-consultation. Clinicians reported disease activity status, therapeutic decisions and clinical management. Results: Patients (GIUS: 70 of 259[27%]; non-GIUS: 189 of 259[73%]) were aged 39.7 ± 12.8 years, 139 of 259 (54%) were male and 159 of 259 (61%) were diagnosed with Crohn's disease. Mean time since diagnosis was 9.4 ± 8.6 years for the GIUS group and 11.3 ± 9.1 years for the non-GIUS group. Immediately after undergoing GIUS, patients with active IBD reported significantly better understanding of all aspects of their disease and improved knowledge

Research paper thumbnail of 1930 A joint MDT clinic may improve adherence to surgery in adolescents and young adults (AYA) with refractory to medical treatment inflammatory bowel diseases (IBD)

Research paper thumbnail of P149 Evaluation of the at-home capsule endoscopy (ACE) service at UCLH: preliminary findings

Research paper thumbnail of Conflict of Interest: None

A 21-year-old male reporting melena over one week is presented. Laboratory testing revealed sever... more A 21-year-old male reporting melena over one week is presented. Laboratory testing revealed severe anemia (Hgb 7 g/dL). Hyperpigmentation spots were present in the patient’s bucal mucosa and lower lip that arose during infancy. Three years ago, these lesions had raised the clinical suspicion of Peutz-Jeghers syndrome (PJS) and the patient had undergone an upper gastrointestinal (GI) endoscopy and barium study of the small bowel, however no lesions were demonstrated. An urgent upper GI endoscopy was performed de mon-strating a largely distended stomach, full of non-hemorrhagic content, suggestive of high intestinal obstruction. Two gastric polyps of ~1.5 cm diameter and multiple small duodenal polyps were also revealed. A second upper GI endoscopy with a PENTAX HD i-scan colonoscope (Pentax EC-3890Li, Pentax, Japan) revealed a large polyp nearly obstructing the enteric lumen after the fourth part of the duodenum (Fig. 1). Histology a

Research paper thumbnail of Comparative effectiveness of a second-line biologic in patients with ulcerative colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab

Frontline Gastroenterology, 2022

BackgroundSequential drug treatment with biological agents in ulcerative colitis (UC) is becoming... more BackgroundSequential drug treatment with biological agents in ulcerative colitis (UC) is becoming increasingly complex. There are few studies comparing head-to-head outcomes in second-line treatments. The study assesses whether using anti-tumour necrosis factor (anti-TNF)-α therapy following the α4β7 integrin blocker vedolizumab (VDZ) or VDZ after an anti-TNF has more favourable clinical outcomes in UC in a real-world outpatient setting.MethodsPatients with UC who were exposed to first-line anti-TNF (adalimumab or infliximab) or VDZ who subsequently switched to the alternate class between May 2013 and August 2020 were identified by reviewing patient databases at 10 hospitals. Data were collected retrospectively using patient records. Baseline demographics, disease activity indices, biochemical markers, endoscopic Mayo score, colectomy rates, treatment persistence and urgent hospital utilisation composite endpoint (UHUC) rates were examined over a 52-week period.ResultsSecond-line we...

Research paper thumbnail of PMO-12 Real-world outcomes after Vedolizumab discontinuation in a tertiary IBD cohort

Research paper thumbnail of PMO-14 Use of non-invasive surrogate markers to monitor vedolizumab therapy in inflammatory bowel disease

Posters, 2021

improvement in median FC levels was seen in those dying from malignancy (1130 to 250ug/g in UC an... more improvement in median FC levels was seen in those dying from malignancy (1130 to 250ug/g in UC and 588 to 490ug/ g in CD). When stratified by age of death the FC measurements were similar between age groups. Conclusions Serious and fatal non-IBD related disease does not seem to lead to spontaneous improvement or deterioration in luminal inflammation prior to death, with no significant 'burn out' of IBD activity seen. For patients approaching the end of their life the aim of treatment focuses on maximising quality of life, but there remains variation in practice around stopping or continuing IBD therapies, and further research in this area is required. This study suggests that for patients with IBD an individualised approach is required, and for many, good palliative care will include active and aggressive management of their IBD.

Research paper thumbnail of P277 Nutritional status and disease activity in crohn’s disease: preliminary data

Posters, 2021

Interventions done involved ward-based education in the first instance to nursing staffs and the ... more Interventions done involved ward-based education in the first instance to nursing staffs and the use of paper reminder for each NG-fed patient. Other interventions include production of an awareness poster and patient's leaflets which were then distributed among cognitively intact post-stroke patients. We also raised awareness among the healthcare staffs in a larger scale through presentation of our QIP during the UHDB Junior Doctors' Grand Round event. Conclusions Despite focus being given on providing prompt swallow assessment and subsequently NG tube insertion to aid feeding for our stroke patients, the incidence of aspiration remains prevalent. Inappropriate bed inclination during NG feeding administration is believed to be one of the reasons and this aspect seems to have been underrated in our clinical practice. Having said this, we do understand that the incidence of aspiration among our patient cohort could be multifactorial. Re-audit data collection is currently ongoing, with the latest set of data demonstrating a good outcome following our interventions.

Research paper thumbnail of Use of steroids in adults and adolescents with Inflammatory Bowel Disease in the biologics era

Research paper thumbnail of Clinical response to Vedolizumab in IBD patients is associated with the concomitant use of immunomodulators

Research paper thumbnail of Inflammation-based scores do not predict post-transplant recurrence of hepatocellular carcinoma in patients within milan criteria

Liver Transplantation, 2014

Increased preoperative inflammation scores, such as neutrophil-to-lymphocyte ratio (NLR), platele... more Increased preoperative inflammation scores, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and inflammation-based index (IBI) have been related to post-transplant HCC recurrence. We evaluated the association between inflammation-based scores (NLR, PLR, IBI) and post-LT HCC recurrence as well as tumor necrosis after transarterial embolization. 150 consecutive patients who underwent transplantation for HCC within the Milan criteria between 1996 and 2010 were included; data regarding inflammatory markers, patient and tumor characteristics were analyzed. NLR, PLR, and IBI were not significantly associated with post-LT HCC recurrence or worse overall survival. Increased NLR and PLR were associated with complete tumor necrosis in the subset of patients who received preoperative transarterial embolization (P < 0.05). Cox regression analysis revealed that absence of neoadjuvant transarterial therapy (OR 5 4.33, 95% CI 5 1.28-14.64; P 5 0.02) and no fulfillment of the Milan criteria in the explanted liver (OR 5 3.34, 95% CI 5 1.08-10.35; P 5 0.04) were independently associated with post-LT HCC recurrence inflammation-based scores did not predict HCC recurrence post-LT in our group of patients. NLR and PLR were associated with better response to TAE, as this was recorded histologically in the explanted liver. Histological fulfillment of the Milan criteria and absence of neoadjuvant transarterial treatment were significantly associated with post-LT HCC recurrence.

Research paper thumbnail of PMO-17 Clinical predictors of Vedolizumab response in Crohn’s disease

Posters, 2021

been newly started and opted for SC administration. Between October and December 2020, all suitab... more been newly started and opted for SC administration. Between October and December 2020, all suitable patients attending our infusion centre for vedolizumab were offered the option to switch to SC. Initially, the aim was to offer a SC dose to patients in place of their IV infusion with injection training by IBD specialists. This proved to be a challenge as it left a narrow window of time for homecare deliveries to be arranged for subsequent doses. Therefore, the remaining patients who agreed to the switch received an IV infusion at their baseline review, with the aim of administering the first SC dose in place of the next scheduled IV dose. Outcomes include reasons for consenting or declining to switch, patient experience with using SC injections and time saved by not needing to travel to the infusion centre. Data on factors associated with poor outcomes from SARS-CoV-2 infection were collected, including co-morbidities, smoking status, concomitant medication and age. Clinical baseline data collected as part of routine care included disease activity (modified Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index), biochemical results including C-reactive protein, albumin, haemoglobin and platelet count, faecal calprotectin and quality of life using IBD-Control. Trough vedolizumab levels were measured in patients who had had at least 3 IV doses previously. Patients will be reviewed after 12 weeks as part of the switching programme. Results 179 patients were offered the opportunity to change to SC vedolizumab (54.2% CD, 44.1% UC, 1.7% IBDU), of which 125 (70%) (64 (51.2%) CD, 58 (46.4%) UC and 3 (2.4%) IBDU) agreed to the switch. The mean age (SD) was 55 (19.4). 11 patients were new to vedolizumab or reloading. The median time taken by patients (leaving home to returning home) to receive their infusions was 180 minutes (IQR 45 to 360). The main reasons for agreeing to switch were patient preference to manage their treatment at home (70.4%), concerns about contracting an infection at the infusion centre (15.7%) and difficulty attending the infusion centre (15.7%). Reasons for patients declining included not wanting to self-inject (28.3%), needle phobia (15.2%), and current instability of symptoms (15.2%). There have been no major adverse events to date. Conclusions This is a description of a service evaluation design to monitor outcomes in patients who have consented to transition from IV to SC vedolizumab at one IBD tertiary referral centre.

Research paper thumbnail of P150 Evaluation of the colon capsule endoscopy service at UCLH in 2021

Research paper thumbnail of Elevated liver enzymes in inflammatory bowel disease: the role and safety of infliximab

European journal of gastroenterology & hepatology, Jan 24, 2016

Abnormal liver enzymes are frequently encountered in inflammatory bowel disease (IBD) patients. I... more Abnormal liver enzymes are frequently encountered in inflammatory bowel disease (IBD) patients. Infliximab has been implicated in inducing drug-induced liver injury, autoimmune hepatitis or reactivation of hepatitis B virus. We aimed to clarify the role of infliximab in liver impairment in an IBD cohort. A total of 305 patients with IBD, without evidence of chronic liver disease, were included in the study and retrospectively evaluated. Laboratory and clinical data were retrieved from a prospectively acquired database. In all, 176 consecutive patients treated with infliximab during the last 5 years were compared with a matched population of 129 patients who did not receive any antitumour necrosis factor treatment. Elevation of alanine transaminase (ALT) was frequent in the entire population (36.4%) and it was not significantly associated with the use of infliximab (P=0.284). Elevations more than 3 upper limit of normal were observed in 7.9% and these resolved spontaneously in 83%. T...

Research paper thumbnail of Incidence and Severity of Prepouch Ileitis: A Distinct Disease Entity or a Manifestation of Refractory Pouchitis?

Inflammatory bowel diseases, Jan 16, 2015

Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for pati... more Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for patients with treatment-refractory ulcerative colitis. However, after this intervention, up to 50% of patients develop pouchitis. Moreover, a subgroup will also develop inflammation in the afferent ileum proximal to the pouch, a condition named prepouch ileitis (PI). Data on 546 patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were retrospectively collected from 3 tertiary inflammatory bowel disease referral centers in the Netherlands, Belgium, and England. PI was considered present if there was endoscopic and histological inflammation in the afferent limb proximal to the pouch. Crohn's disease was excluded by reviewing the histology of colectomy resection specimens. PI was present in 33/546 (6%) patients and all of these had concurrent pouchitis. One hundred forty-four (26%) patients had pouchitis without PI and 369 (68%) patients did not have inflammatory pouc...

Research paper thumbnail of Incidence and Severity of Prepouch Ileitis

Inflammatory Bowel Diseases, 2015

Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for pati... more Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for patients with treatment-refractory ulcerative colitis. However, after this intervention, up to 50% of patients develop pouchitis. Moreover, a subgroup will also develop inflammation in the afferent ileum proximal to the pouch, a condition named prepouch ileitis (PI). Data on 546 patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were retrospectively collected from 3 tertiary inflammatory bowel disease referral centers in the Netherlands, Belgium, and England. PI was considered present if there was endoscopic and histological inflammation in the afferent limb proximal to the pouch. Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease was excluded by reviewing the histology of colectomy resection specimens. PI was present in 33/546 (6%) patients and all of these had concurrent pouchitis. One hundred forty-four (26%) patients had pouchitis without PI and 369 (68%) patients did not have inflammatory pouch disease. Of the 33 patients with PI, 6 (18%) received no specific treatment, 9 (27%) responded to antibiotics, and 18 (54%) required escalation in therapy to steroids/immunomodulators or anti-tumor necrosis factor agents. Potent immunosuppressive treatment was required more frequently in patients with PI than those with pouchitis alone. PI is less common and more treatment refractory than pouchitis alone. Once PI is diagnosed, clinicians should be aware that response to antibiotic therapy is less likely than in pouchitis alone. Immunomodulatory therapy and escalation to anti-tumor necrosis factor agents should be considered early in cases of nonresponse. The suggestion that PI represents misdiagnosed Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease could not be substantiated in our cohort.

Research paper thumbnail of Su1658 Incidence and Severity of Pre-Pouch Ileitis: a Distinct Disease Entity or a Manifestation of Refractory Pouchitis?

Gastrointestinal Endoscopy, 2015

Research paper thumbnail of Magnetic resonance enteroclysis for Peutz-Jeghers syndrome

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2011

Research paper thumbnail of Inflammation-based scores and hepatocellular carcinoma - authors' reply

Liver Transplantation, 2014

Research paper thumbnail of P445 Does The Sequence Matter ? Comparative effectiveness of a second line biologic in patients with Ulcerative Colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab

Journal of Crohn's and Colitis, 2021

Background Drug choice and order in Inflammatory Bowel Disease (IBD) is an important challenge an... more Background Drug choice and order in Inflammatory Bowel Disease (IBD) is an important challenge and is becoming increasingly complex. There are few studies comparing head-to-head outcomes in second line treatments in Ulcerative Colitis (UC). It is unclear if using anti-Tumour Necrosis Factor-a (anti-TNF) therapy following vedolizumab (VDZ) or VDZ after anti-TNF has a more favourable outcome in UC in a real-world outpatient setting. Methods Patients with UC who were exposed to first-line anti-TNF (adalimumab/ADA or infliximab/IFX) or VDZ who subsequently switched to the alternate class between May 2013-August 2020 were identified following a review of databases at 10 hospitals. 88 VDZ and 39 anti-TNF (12 ADA,27 IFX) second line patients were eligible. Data was collected retrospectively. Baseline demographics, disease activity indices, colectomy rates, treatment persistence and healthcare resource utilisation composite endpoint (HRUC) were examined over a 52 week period for the second ...

Research paper thumbnail of P592 Efficacy of vedolizumab for induction and maintenance of clinical remission in ulcerative colitis: The UCLH experience

Journal of Crohn's and Colitis, 2018

Background: There is limited utilisation of gastrointestinal ultrasonography (GIUS) in inflammato... more Background: There is limited utilisation of gastrointestinal ultrasonography (GIUS) in inflammatory bowel disease (IBD) by clinicians around the world. This study evaluated the benefits of IUS in IBD management from the patient's perspective and the value of GIUS in clinical decision-making. Methods: This was an observational, non-interventional cohort study investigating the real-world clinical management of patients (≥18 years of age) diagnosed with IBD. During routine outpatient consultations, patients were allocated to receive GIUS or not according to their clinical requirements. Patients completed self-reported questionnaires at study entry, immediately after their consultation and then at 4 and 16 weeks post-consultation. Clinicians reported disease activity status, therapeutic decisions and clinical management. Results: Patients (GIUS: 70 of 259[27%]; non-GIUS: 189 of 259[73%]) were aged 39.7 ± 12.8 years, 139 of 259 (54%) were male and 159 of 259 (61%) were diagnosed with Crohn's disease. Mean time since diagnosis was 9.4 ± 8.6 years for the GIUS group and 11.3 ± 9.1 years for the non-GIUS group. Immediately after undergoing GIUS, patients with active IBD reported significantly better understanding of all aspects of their disease and improved knowledge

Research paper thumbnail of 1930 A joint MDT clinic may improve adherence to surgery in adolescents and young adults (AYA) with refractory to medical treatment inflammatory bowel diseases (IBD)

Research paper thumbnail of P149 Evaluation of the at-home capsule endoscopy (ACE) service at UCLH: preliminary findings

Research paper thumbnail of Conflict of Interest: None

A 21-year-old male reporting melena over one week is presented. Laboratory testing revealed sever... more A 21-year-old male reporting melena over one week is presented. Laboratory testing revealed severe anemia (Hgb 7 g/dL). Hyperpigmentation spots were present in the patient’s bucal mucosa and lower lip that arose during infancy. Three years ago, these lesions had raised the clinical suspicion of Peutz-Jeghers syndrome (PJS) and the patient had undergone an upper gastrointestinal (GI) endoscopy and barium study of the small bowel, however no lesions were demonstrated. An urgent upper GI endoscopy was performed de mon-strating a largely distended stomach, full of non-hemorrhagic content, suggestive of high intestinal obstruction. Two gastric polyps of ~1.5 cm diameter and multiple small duodenal polyps were also revealed. A second upper GI endoscopy with a PENTAX HD i-scan colonoscope (Pentax EC-3890Li, Pentax, Japan) revealed a large polyp nearly obstructing the enteric lumen after the fourth part of the duodenum (Fig. 1). Histology a

Research paper thumbnail of Comparative effectiveness of a second-line biologic in patients with ulcerative colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab

Frontline Gastroenterology, 2022

BackgroundSequential drug treatment with biological agents in ulcerative colitis (UC) is becoming... more BackgroundSequential drug treatment with biological agents in ulcerative colitis (UC) is becoming increasingly complex. There are few studies comparing head-to-head outcomes in second-line treatments. The study assesses whether using anti-tumour necrosis factor (anti-TNF)-α therapy following the α4β7 integrin blocker vedolizumab (VDZ) or VDZ after an anti-TNF has more favourable clinical outcomes in UC in a real-world outpatient setting.MethodsPatients with UC who were exposed to first-line anti-TNF (adalimumab or infliximab) or VDZ who subsequently switched to the alternate class between May 2013 and August 2020 were identified by reviewing patient databases at 10 hospitals. Data were collected retrospectively using patient records. Baseline demographics, disease activity indices, biochemical markers, endoscopic Mayo score, colectomy rates, treatment persistence and urgent hospital utilisation composite endpoint (UHUC) rates were examined over a 52-week period.ResultsSecond-line we...

Research paper thumbnail of PMO-12 Real-world outcomes after Vedolizumab discontinuation in a tertiary IBD cohort

Research paper thumbnail of PMO-14 Use of non-invasive surrogate markers to monitor vedolizumab therapy in inflammatory bowel disease

Posters, 2021

improvement in median FC levels was seen in those dying from malignancy (1130 to 250ug/g in UC an... more improvement in median FC levels was seen in those dying from malignancy (1130 to 250ug/g in UC and 588 to 490ug/ g in CD). When stratified by age of death the FC measurements were similar between age groups. Conclusions Serious and fatal non-IBD related disease does not seem to lead to spontaneous improvement or deterioration in luminal inflammation prior to death, with no significant 'burn out' of IBD activity seen. For patients approaching the end of their life the aim of treatment focuses on maximising quality of life, but there remains variation in practice around stopping or continuing IBD therapies, and further research in this area is required. This study suggests that for patients with IBD an individualised approach is required, and for many, good palliative care will include active and aggressive management of their IBD.

Research paper thumbnail of P277 Nutritional status and disease activity in crohn’s disease: preliminary data

Posters, 2021

Interventions done involved ward-based education in the first instance to nursing staffs and the ... more Interventions done involved ward-based education in the first instance to nursing staffs and the use of paper reminder for each NG-fed patient. Other interventions include production of an awareness poster and patient's leaflets which were then distributed among cognitively intact post-stroke patients. We also raised awareness among the healthcare staffs in a larger scale through presentation of our QIP during the UHDB Junior Doctors' Grand Round event. Conclusions Despite focus being given on providing prompt swallow assessment and subsequently NG tube insertion to aid feeding for our stroke patients, the incidence of aspiration remains prevalent. Inappropriate bed inclination during NG feeding administration is believed to be one of the reasons and this aspect seems to have been underrated in our clinical practice. Having said this, we do understand that the incidence of aspiration among our patient cohort could be multifactorial. Re-audit data collection is currently ongoing, with the latest set of data demonstrating a good outcome following our interventions.

Research paper thumbnail of Use of steroids in adults and adolescents with Inflammatory Bowel Disease in the biologics era

Research paper thumbnail of Clinical response to Vedolizumab in IBD patients is associated with the concomitant use of immunomodulators

Research paper thumbnail of Inflammation-based scores do not predict post-transplant recurrence of hepatocellular carcinoma in patients within milan criteria

Liver Transplantation, 2014

Increased preoperative inflammation scores, such as neutrophil-to-lymphocyte ratio (NLR), platele... more Increased preoperative inflammation scores, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and inflammation-based index (IBI) have been related to post-transplant HCC recurrence. We evaluated the association between inflammation-based scores (NLR, PLR, IBI) and post-LT HCC recurrence as well as tumor necrosis after transarterial embolization. 150 consecutive patients who underwent transplantation for HCC within the Milan criteria between 1996 and 2010 were included; data regarding inflammatory markers, patient and tumor characteristics were analyzed. NLR, PLR, and IBI were not significantly associated with post-LT HCC recurrence or worse overall survival. Increased NLR and PLR were associated with complete tumor necrosis in the subset of patients who received preoperative transarterial embolization (P < 0.05). Cox regression analysis revealed that absence of neoadjuvant transarterial therapy (OR 5 4.33, 95% CI 5 1.28-14.64; P 5 0.02) and no fulfillment of the Milan criteria in the explanted liver (OR 5 3.34, 95% CI 5 1.08-10.35; P 5 0.04) were independently associated with post-LT HCC recurrence inflammation-based scores did not predict HCC recurrence post-LT in our group of patients. NLR and PLR were associated with better response to TAE, as this was recorded histologically in the explanted liver. Histological fulfillment of the Milan criteria and absence of neoadjuvant transarterial treatment were significantly associated with post-LT HCC recurrence.

Research paper thumbnail of PMO-17 Clinical predictors of Vedolizumab response in Crohn’s disease

Posters, 2021

been newly started and opted for SC administration. Between October and December 2020, all suitab... more been newly started and opted for SC administration. Between October and December 2020, all suitable patients attending our infusion centre for vedolizumab were offered the option to switch to SC. Initially, the aim was to offer a SC dose to patients in place of their IV infusion with injection training by IBD specialists. This proved to be a challenge as it left a narrow window of time for homecare deliveries to be arranged for subsequent doses. Therefore, the remaining patients who agreed to the switch received an IV infusion at their baseline review, with the aim of administering the first SC dose in place of the next scheduled IV dose. Outcomes include reasons for consenting or declining to switch, patient experience with using SC injections and time saved by not needing to travel to the infusion centre. Data on factors associated with poor outcomes from SARS-CoV-2 infection were collected, including co-morbidities, smoking status, concomitant medication and age. Clinical baseline data collected as part of routine care included disease activity (modified Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index), biochemical results including C-reactive protein, albumin, haemoglobin and platelet count, faecal calprotectin and quality of life using IBD-Control. Trough vedolizumab levels were measured in patients who had had at least 3 IV doses previously. Patients will be reviewed after 12 weeks as part of the switching programme. Results 179 patients were offered the opportunity to change to SC vedolizumab (54.2% CD, 44.1% UC, 1.7% IBDU), of which 125 (70%) (64 (51.2%) CD, 58 (46.4%) UC and 3 (2.4%) IBDU) agreed to the switch. The mean age (SD) was 55 (19.4). 11 patients were new to vedolizumab or reloading. The median time taken by patients (leaving home to returning home) to receive their infusions was 180 minutes (IQR 45 to 360). The main reasons for agreeing to switch were patient preference to manage their treatment at home (70.4%), concerns about contracting an infection at the infusion centre (15.7%) and difficulty attending the infusion centre (15.7%). Reasons for patients declining included not wanting to self-inject (28.3%), needle phobia (15.2%), and current instability of symptoms (15.2%). There have been no major adverse events to date. Conclusions This is a description of a service evaluation design to monitor outcomes in patients who have consented to transition from IV to SC vedolizumab at one IBD tertiary referral centre.

Research paper thumbnail of P150 Evaluation of the colon capsule endoscopy service at UCLH in 2021

Research paper thumbnail of Elevated liver enzymes in inflammatory bowel disease: the role and safety of infliximab

European journal of gastroenterology & hepatology, Jan 24, 2016

Abnormal liver enzymes are frequently encountered in inflammatory bowel disease (IBD) patients. I... more Abnormal liver enzymes are frequently encountered in inflammatory bowel disease (IBD) patients. Infliximab has been implicated in inducing drug-induced liver injury, autoimmune hepatitis or reactivation of hepatitis B virus. We aimed to clarify the role of infliximab in liver impairment in an IBD cohort. A total of 305 patients with IBD, without evidence of chronic liver disease, were included in the study and retrospectively evaluated. Laboratory and clinical data were retrieved from a prospectively acquired database. In all, 176 consecutive patients treated with infliximab during the last 5 years were compared with a matched population of 129 patients who did not receive any antitumour necrosis factor treatment. Elevation of alanine transaminase (ALT) was frequent in the entire population (36.4%) and it was not significantly associated with the use of infliximab (P=0.284). Elevations more than 3 upper limit of normal were observed in 7.9% and these resolved spontaneously in 83%. T...

Research paper thumbnail of Incidence and Severity of Prepouch Ileitis: A Distinct Disease Entity or a Manifestation of Refractory Pouchitis?

Inflammatory bowel diseases, Jan 16, 2015

Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for pati... more Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for patients with treatment-refractory ulcerative colitis. However, after this intervention, up to 50% of patients develop pouchitis. Moreover, a subgroup will also develop inflammation in the afferent ileum proximal to the pouch, a condition named prepouch ileitis (PI). Data on 546 patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were retrospectively collected from 3 tertiary inflammatory bowel disease referral centers in the Netherlands, Belgium, and England. PI was considered present if there was endoscopic and histological inflammation in the afferent limb proximal to the pouch. Crohn's disease was excluded by reviewing the histology of colectomy resection specimens. PI was present in 33/546 (6%) patients and all of these had concurrent pouchitis. One hundred forty-four (26%) patients had pouchitis without PI and 369 (68%) patients did not have inflammatory pouc...

Research paper thumbnail of Incidence and Severity of Prepouch Ileitis

Inflammatory Bowel Diseases, 2015

Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for pati... more Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for patients with treatment-refractory ulcerative colitis. However, after this intervention, up to 50% of patients develop pouchitis. Moreover, a subgroup will also develop inflammation in the afferent ileum proximal to the pouch, a condition named prepouch ileitis (PI). Data on 546 patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were retrospectively collected from 3 tertiary inflammatory bowel disease referral centers in the Netherlands, Belgium, and England. PI was considered present if there was endoscopic and histological inflammation in the afferent limb proximal to the pouch. Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease was excluded by reviewing the histology of colectomy resection specimens. PI was present in 33/546 (6%) patients and all of these had concurrent pouchitis. One hundred forty-four (26%) patients had pouchitis without PI and 369 (68%) patients did not have inflammatory pouch disease. Of the 33 patients with PI, 6 (18%) received no specific treatment, 9 (27%) responded to antibiotics, and 18 (54%) required escalation in therapy to steroids/immunomodulators or anti-tumor necrosis factor agents. Potent immunosuppressive treatment was required more frequently in patients with PI than those with pouchitis alone. PI is less common and more treatment refractory than pouchitis alone. Once PI is diagnosed, clinicians should be aware that response to antibiotic therapy is less likely than in pouchitis alone. Immunomodulatory therapy and escalation to anti-tumor necrosis factor agents should be considered early in cases of nonresponse. The suggestion that PI represents misdiagnosed Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease could not be substantiated in our cohort.

Research paper thumbnail of Su1658 Incidence and Severity of Pre-Pouch Ileitis: a Distinct Disease Entity or a Manifestation of Refractory Pouchitis?

Gastrointestinal Endoscopy, 2015

Research paper thumbnail of Magnetic resonance enteroclysis for Peutz-Jeghers syndrome

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2011

Research paper thumbnail of Inflammation-based scores and hepatocellular carcinoma - authors' reply

Liver Transplantation, 2014