Philippe Van Hootegem - Academia.edu (original) (raw)
Papers by Philippe Van Hootegem
United European Gastroenterology Journal, 2021
Digestive healthcare is one of the medical disciplines strongly impacted by the SARS-CoV-2 outbre... more Digestive healthcare is one of the medical disciplines strongly impacted by the SARS-CoV-2 outbreak and the implemented restrictions (1). Endoscopy has been one of the most affected procedures, leading to a dramatic decrease of screening and surveillance procedures. On the other hand, lockdowns and social distancing have been associated with unhealthy eating habits, decreased physical exercise and alcohol consumption (2). The COVID-19 vaccination process is currently of great importance. With GI patients being vulnerable to increased morbidity and worse outcomes from the SARS-CoV-2 infection, strategies to better protect the health of patients with impaired immunity must be a priority. This position paper serves to inform policy makers, patients, healthcare professionals and the general public of the latest evidence on the impacts of the SARS-CoV-2 pandemic on digestive health. In the same vein, it aims to improve understanding of the clinical considerations on the use of COVID-19 vaccines in patients with chronic digestive conditions and to present UEG's latest recommendations to support evidence-informed decision making. * * All the information is based on evidence available at the time of publication (19.10. 2021
Acta gastro-enterologica Belgica
Neuroendocrine tumors (NETs) are relatively rare neoplasms that often present as diagnostic dilem... more Neuroendocrine tumors (NETs) are relatively rare neoplasms that often present as diagnostic dilemmas due to obscure or non-specific symptoms. The ability of carcinoid tumors to cause clinical symptoms by secretion of hormones or biogenic amines is best recognised in the form of the carcinoid syndrome. Although generally slow growing, a significant minority demonstrate aggressive tumor growth. Ten-twenty percent of pancreatic NETs may be associated with hereditary disorders such as multiple endocrine neoplasia-1 (MEN-1) and less frequently, Von Hippel Lindau, which should be considered in the investigation and management of these patients. A small percentage of NETs are associated with co-existing synchronous non-carcinoid neoplasm. The aim of this paper was to review the optimal management in patients with NETs. The therapeutic options which are reviewed, including the use of somatostatin analogues, the role of surgery, the use of chemotherapy, biotherapy using interferon, peptide receptor targeted therapy. In addition, the challenging interventional management of liver metastases is discussed, including the role of hepatic-artery embolization, radiofrequency ablation and the place of orthotoptic liver transplantation in selected patients. Authors have focused on the newest therapeutic modalities, e.g., radionuclide peptide receptor targeted therapy with Yttrium-90 and Lutetium-177, the newest somatostatin analogues such as pasireotide and angiogenic inhibitors. In conclusion, with the increasing number of investigative procedures and therapeutic options available to diagnose and treat carcinoid tumors, it is vital to have a multidisciplinary approach. Furthermore, additional scientific research and controlled clinical trials are needed to determine the efficacy of the many treatment options, which for these rare tumors can only be achieved by collaboration.
Journal of Crohn's and Colitis, 2019
The emergence of biosimilars is generally considered as an opportunity to guarantee accessibility... more The emergence of biosimilars is generally considered as an opportunity to guarantee accessibility to affordable treatments and to enhance financial sustainability of national health systems. Since 2017 five biosimilars of adalimumab were approved by EMA for use in inflammatory bowel disease: ABP 510, SB5, GP2017, FKB327 and MSB11022. In this position statement, the available efficacy and safety data of the different adalimumab biosimilars in immune mediated inflammatory diseases are summarized. Furthermore, the Belgian IBD research group (BIRD) formulates statements concerning the use of adalimumab biosimilars in inflammatory bowel disease.
Journal of Crohn’s and Colitis, 2019
In 1932 Burrill B. Crohn, a gastroenterologist at Mount Sinai Hospital in New York City described... more In 1932 Burrill B. Crohn, a gastroenterologist at Mount Sinai Hospital in New York City described, together with two surgical colleagues, a series of 14 patients with an inflammatory condition of the terminal ileum. All patients were operated on by Dr Albert Berg, the Chief Surgeon of the hospital, whose name did not appear on the initial publication. The “new” disease was called “regional ileitis”, but was rapidly referred to as “Crohn’s disease”. From earlier accounts and publications it has become clear that the condition had already existed for many centuries and was “discovered” several times before 1932, most notably by Giovanni Morgagni in 1769, Antoni Lesniowski in 1903 and Thomas K. Dalziel in 1913. ‘Crohn’s disease’ might reasonably be known by another eponym. Nevertheless, the 1932 publication of Crohn was pivotal, as were his later contributions to the knowledge of “his” disease. Therefore the worldwide use of the eponym is rightly to be continued. Present researchers an...
peer reviewedBackground Tofacitinib, an oral small molecule Janus kinase inhibitor, has been appr... more peer reviewedBackground Tofacitinib, an oral small molecule Janus kinase inhibitor, has been approved in 2018 for the treatment of moderate to severe ulcerative colitis (UC) in Europe. We report on real-world short-term efficacy and safety data from a multicenter Belgium refractory cohort of UC patients with prior exposure to both anti-TNF and vedolizumab. Methods This is an observational, national, retrospective multicenter study including all UC active patients started on tofacitinib (10 mg BID) from 25 centers in Belgium between November 2018 to August 2019. Prospectively collected data were retrospectively analyzed according intention-to-treat. Primary endpoints were clinical and endoscopic response and remission rates at weeks 8 and 16. Clinical response and remission were defined as a reduction in Modified Clinical Mayo score (rectal bleeding, stool frequency) of ≥2 and ≤1, respectively. Endoscopic response and remission were defined as a reduction in Endoscopic Mayo score of ...
GastroHep, 2021
Dose intensification of vedolizumab (VDZ) for moderate‐to‐severe ulcerative colitis (UC) and Croh... more Dose intensification of vedolizumab (VDZ) for moderate‐to‐severe ulcerative colitis (UC) and Crohn's disease (CD) may be effective in patients losing response. We aimed to assess the clinical and pharmacokinetic effect of VDZ dose intensification.
Journal of Clinical Gastroenterology, 1988
One hundred thirty-three patients (34.5% Child's C class) with at least one severe variceal h... more One hundred thirty-three patients (34.5% Child's C class) with at least one severe variceal hemorrhage and treated with repeated endoscopic sclerotherapy had a follow-up of 1-6 years (mean 20 months). The risk of rebleeding decreased significantly from 2 months after onset of sclerotherapy. Sixty-four patients (or 48%) rebled, within 2 months in 45 (70%). The incidence of rebleeding correlated with Child's category and with the size of the varices. The 2-month mortality rate was 28.6%; two-thirds died of severe rebleeding. Thirteen patients underwent emergency surgery for bleeding uncontrolled by sclerotherapy; nine of them died. Of the 120 treated only by sclerotherapy 93% ultimately died, 90% from variceal rebleeding. Mortality related to the liver disease was thus determined by rebleeding mainly within 2 months and by hepatic failure but not by etiology of the disease or number of previous hemorrhages. The more pronounced mortality in Child C versus B or A patients is thus due to early rebleeding and to more pronounced liver insufficiency in the early and later period. Varices could not be eradicated within 1 year by sclerotherapy in 9 patients; 68 of the 72 patients alive had total eradication, but recurrence of varices was observed in 19 (or 28%) within 1 year, independent of the etiology and severity of liver disease and varices. Only four patients rebled within 1 year, with no mortality. After 1-4 years, another five recurrences were noted, with two nonfatal bleeding episodes. This study argues for continuation of sclerotherapy until total eradication of varices as well as for regular follow-up to avoid recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical Gastroenterology and Hepatology, 2020
Inflammatory bowel diseases, Jan 15, 2018
Golimumab (GOL) is registered for moderate to severely active ulcerative colitis (UC). Data on th... more Golimumab (GOL) is registered for moderate to severely active ulcerative colitis (UC). Data on the use of GOL in daily clinical practice are limited. Currently, it is unclear which factors are predictive of a favorable outcome. The goals of this study were to evaluate the mid-term outcome of GOL (week 26) in patients with moderate to severe UC and to determine predictors of favorable outcome. Patients included in the SMART study (NCT02155335) were evaluated for their mid-term outcome. Demographic data, disease characteristics, and medical history were recorded retrospectively. Data on disease activity based on total Mayo score, previous and concomitant medication, GOL dosing, mucosal healing (Mayo 0 or 1), adverse events (colectomy, hospitalization), and biomarkers (C-reactive protein, fecal calprotectin, hemoglobin, and albumin) were collected at baseline and weeks 2, 6, 14, 26, and 52. GOL was dosed at 200 and 100 mg at weeks 0 and 2, respectively, and 50 mg (<80 kg body weight...
Gastroenterology, Apr 6, 2018
A combination of infliximab and immunomodulators is the most efficacious treatment for Crohn'... more A combination of infliximab and immunomodulators is the most efficacious treatment for Crohn's disease (CD). Patients have the best outcomes when their serum concentrations of these drugs are above a determined therapeutic threshold. We performed a prospective, randomized trial to determine whether therapeutic drug monitoring (TDM) to maintain serum levels of infliximab above 3 μg/mL produced higher rates of clinical and endoscopic remission than adapting dose based only on symptoms. We performed a double-blind trial in which 122 biologic-naïve adult patients with active CD (71 female, median age 29.8 years) received induction treatment with infliximab in combination with an immunosuppressant, from July 2012 through September 2015 at 27 centers in Europe. At week 14 of treatment, patients were randomly assigned (1:1:1) to 3 infliximab maintenance groups: dose increases (2 maximum) in steps of 2.5 mg/kg based on clinical symptoms and biomarker analysis and/or serum infliximab con...
Acta gastro-enterologica Belgica
Nederlands tijdschrift voor geneeskunde, Jan 7, 1998
Two patients, one 76-year-old-man and one 79-year-old-woman with cardiovascular disease and one 3... more Two patients, one 76-year-old-man and one 79-year-old-woman with cardiovascular disease and one 36-year-old-man with Factor-V-Leiden deficiency (activated protein C-resistance) had abdominal pain and elevation of LDH levels. With abdominal CT scan kidney infarction was diagnosed. In two cases a selective kidney arteriography was performed to confirm the diagnosis. Treatment consisted of (re)starting anticoagulant therapy. In unexplained abdominal pain with insufficiently specific results of physical examination combined with a rapid rise of the LDH and sometimes of the serum creatinine, a kidney infarction should be considered in the differential diagnosis.
Acta gastro-enterologica Belgica
United European Gastroenterology Journal, 2021
Digestive healthcare is one of the medical disciplines strongly impacted by the SARS-CoV-2 outbre... more Digestive healthcare is one of the medical disciplines strongly impacted by the SARS-CoV-2 outbreak and the implemented restrictions (1). Endoscopy has been one of the most affected procedures, leading to a dramatic decrease of screening and surveillance procedures. On the other hand, lockdowns and social distancing have been associated with unhealthy eating habits, decreased physical exercise and alcohol consumption (2). The COVID-19 vaccination process is currently of great importance. With GI patients being vulnerable to increased morbidity and worse outcomes from the SARS-CoV-2 infection, strategies to better protect the health of patients with impaired immunity must be a priority. This position paper serves to inform policy makers, patients, healthcare professionals and the general public of the latest evidence on the impacts of the SARS-CoV-2 pandemic on digestive health. In the same vein, it aims to improve understanding of the clinical considerations on the use of COVID-19 vaccines in patients with chronic digestive conditions and to present UEG's latest recommendations to support evidence-informed decision making. * * All the information is based on evidence available at the time of publication (19.10. 2021
Acta gastro-enterologica Belgica
Neuroendocrine tumors (NETs) are relatively rare neoplasms that often present as diagnostic dilem... more Neuroendocrine tumors (NETs) are relatively rare neoplasms that often present as diagnostic dilemmas due to obscure or non-specific symptoms. The ability of carcinoid tumors to cause clinical symptoms by secretion of hormones or biogenic amines is best recognised in the form of the carcinoid syndrome. Although generally slow growing, a significant minority demonstrate aggressive tumor growth. Ten-twenty percent of pancreatic NETs may be associated with hereditary disorders such as multiple endocrine neoplasia-1 (MEN-1) and less frequently, Von Hippel Lindau, which should be considered in the investigation and management of these patients. A small percentage of NETs are associated with co-existing synchronous non-carcinoid neoplasm. The aim of this paper was to review the optimal management in patients with NETs. The therapeutic options which are reviewed, including the use of somatostatin analogues, the role of surgery, the use of chemotherapy, biotherapy using interferon, peptide receptor targeted therapy. In addition, the challenging interventional management of liver metastases is discussed, including the role of hepatic-artery embolization, radiofrequency ablation and the place of orthotoptic liver transplantation in selected patients. Authors have focused on the newest therapeutic modalities, e.g., radionuclide peptide receptor targeted therapy with Yttrium-90 and Lutetium-177, the newest somatostatin analogues such as pasireotide and angiogenic inhibitors. In conclusion, with the increasing number of investigative procedures and therapeutic options available to diagnose and treat carcinoid tumors, it is vital to have a multidisciplinary approach. Furthermore, additional scientific research and controlled clinical trials are needed to determine the efficacy of the many treatment options, which for these rare tumors can only be achieved by collaboration.
Journal of Crohn's and Colitis, 2019
The emergence of biosimilars is generally considered as an opportunity to guarantee accessibility... more The emergence of biosimilars is generally considered as an opportunity to guarantee accessibility to affordable treatments and to enhance financial sustainability of national health systems. Since 2017 five biosimilars of adalimumab were approved by EMA for use in inflammatory bowel disease: ABP 510, SB5, GP2017, FKB327 and MSB11022. In this position statement, the available efficacy and safety data of the different adalimumab biosimilars in immune mediated inflammatory diseases are summarized. Furthermore, the Belgian IBD research group (BIRD) formulates statements concerning the use of adalimumab biosimilars in inflammatory bowel disease.
Journal of Crohn’s and Colitis, 2019
In 1932 Burrill B. Crohn, a gastroenterologist at Mount Sinai Hospital in New York City described... more In 1932 Burrill B. Crohn, a gastroenterologist at Mount Sinai Hospital in New York City described, together with two surgical colleagues, a series of 14 patients with an inflammatory condition of the terminal ileum. All patients were operated on by Dr Albert Berg, the Chief Surgeon of the hospital, whose name did not appear on the initial publication. The “new” disease was called “regional ileitis”, but was rapidly referred to as “Crohn’s disease”. From earlier accounts and publications it has become clear that the condition had already existed for many centuries and was “discovered” several times before 1932, most notably by Giovanni Morgagni in 1769, Antoni Lesniowski in 1903 and Thomas K. Dalziel in 1913. ‘Crohn’s disease’ might reasonably be known by another eponym. Nevertheless, the 1932 publication of Crohn was pivotal, as were his later contributions to the knowledge of “his” disease. Therefore the worldwide use of the eponym is rightly to be continued. Present researchers an...
peer reviewedBackground Tofacitinib, an oral small molecule Janus kinase inhibitor, has been appr... more peer reviewedBackground Tofacitinib, an oral small molecule Janus kinase inhibitor, has been approved in 2018 for the treatment of moderate to severe ulcerative colitis (UC) in Europe. We report on real-world short-term efficacy and safety data from a multicenter Belgium refractory cohort of UC patients with prior exposure to both anti-TNF and vedolizumab. Methods This is an observational, national, retrospective multicenter study including all UC active patients started on tofacitinib (10 mg BID) from 25 centers in Belgium between November 2018 to August 2019. Prospectively collected data were retrospectively analyzed according intention-to-treat. Primary endpoints were clinical and endoscopic response and remission rates at weeks 8 and 16. Clinical response and remission were defined as a reduction in Modified Clinical Mayo score (rectal bleeding, stool frequency) of ≥2 and ≤1, respectively. Endoscopic response and remission were defined as a reduction in Endoscopic Mayo score of ...
GastroHep, 2021
Dose intensification of vedolizumab (VDZ) for moderate‐to‐severe ulcerative colitis (UC) and Croh... more Dose intensification of vedolizumab (VDZ) for moderate‐to‐severe ulcerative colitis (UC) and Crohn's disease (CD) may be effective in patients losing response. We aimed to assess the clinical and pharmacokinetic effect of VDZ dose intensification.
Journal of Clinical Gastroenterology, 1988
One hundred thirty-three patients (34.5% Child's C class) with at least one severe variceal h... more One hundred thirty-three patients (34.5% Child's C class) with at least one severe variceal hemorrhage and treated with repeated endoscopic sclerotherapy had a follow-up of 1-6 years (mean 20 months). The risk of rebleeding decreased significantly from 2 months after onset of sclerotherapy. Sixty-four patients (or 48%) rebled, within 2 months in 45 (70%). The incidence of rebleeding correlated with Child's category and with the size of the varices. The 2-month mortality rate was 28.6%; two-thirds died of severe rebleeding. Thirteen patients underwent emergency surgery for bleeding uncontrolled by sclerotherapy; nine of them died. Of the 120 treated only by sclerotherapy 93% ultimately died, 90% from variceal rebleeding. Mortality related to the liver disease was thus determined by rebleeding mainly within 2 months and by hepatic failure but not by etiology of the disease or number of previous hemorrhages. The more pronounced mortality in Child C versus B or A patients is thus due to early rebleeding and to more pronounced liver insufficiency in the early and later period. Varices could not be eradicated within 1 year by sclerotherapy in 9 patients; 68 of the 72 patients alive had total eradication, but recurrence of varices was observed in 19 (or 28%) within 1 year, independent of the etiology and severity of liver disease and varices. Only four patients rebled within 1 year, with no mortality. After 1-4 years, another five recurrences were noted, with two nonfatal bleeding episodes. This study argues for continuation of sclerotherapy until total eradication of varices as well as for regular follow-up to avoid recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical Gastroenterology and Hepatology, 2020
Inflammatory bowel diseases, Jan 15, 2018
Golimumab (GOL) is registered for moderate to severely active ulcerative colitis (UC). Data on th... more Golimumab (GOL) is registered for moderate to severely active ulcerative colitis (UC). Data on the use of GOL in daily clinical practice are limited. Currently, it is unclear which factors are predictive of a favorable outcome. The goals of this study were to evaluate the mid-term outcome of GOL (week 26) in patients with moderate to severe UC and to determine predictors of favorable outcome. Patients included in the SMART study (NCT02155335) were evaluated for their mid-term outcome. Demographic data, disease characteristics, and medical history were recorded retrospectively. Data on disease activity based on total Mayo score, previous and concomitant medication, GOL dosing, mucosal healing (Mayo 0 or 1), adverse events (colectomy, hospitalization), and biomarkers (C-reactive protein, fecal calprotectin, hemoglobin, and albumin) were collected at baseline and weeks 2, 6, 14, 26, and 52. GOL was dosed at 200 and 100 mg at weeks 0 and 2, respectively, and 50 mg (<80 kg body weight...
Gastroenterology, Apr 6, 2018
A combination of infliximab and immunomodulators is the most efficacious treatment for Crohn'... more A combination of infliximab and immunomodulators is the most efficacious treatment for Crohn's disease (CD). Patients have the best outcomes when their serum concentrations of these drugs are above a determined therapeutic threshold. We performed a prospective, randomized trial to determine whether therapeutic drug monitoring (TDM) to maintain serum levels of infliximab above 3 μg/mL produced higher rates of clinical and endoscopic remission than adapting dose based only on symptoms. We performed a double-blind trial in which 122 biologic-naïve adult patients with active CD (71 female, median age 29.8 years) received induction treatment with infliximab in combination with an immunosuppressant, from July 2012 through September 2015 at 27 centers in Europe. At week 14 of treatment, patients were randomly assigned (1:1:1) to 3 infliximab maintenance groups: dose increases (2 maximum) in steps of 2.5 mg/kg based on clinical symptoms and biomarker analysis and/or serum infliximab con...
Acta gastro-enterologica Belgica
Nederlands tijdschrift voor geneeskunde, Jan 7, 1998
Two patients, one 76-year-old-man and one 79-year-old-woman with cardiovascular disease and one 3... more Two patients, one 76-year-old-man and one 79-year-old-woman with cardiovascular disease and one 36-year-old-man with Factor-V-Leiden deficiency (activated protein C-resistance) had abdominal pain and elevation of LDH levels. With abdominal CT scan kidney infarction was diagnosed. In two cases a selective kidney arteriography was performed to confirm the diagnosis. Treatment consisted of (re)starting anticoagulant therapy. In unexplained abdominal pain with insufficiently specific results of physical examination combined with a rapid rise of the LDH and sometimes of the serum creatinine, a kidney infarction should be considered in the differential diagnosis.
Acta gastro-enterologica Belgica