Antonio Colecchia - personale UniMoRe

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Antonio COLECCHIA

Professore Ordinario
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa

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Pubblicazioni

2023 - Accuracy of spleen stiffness measurement for the diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease: a systematic review and individual patient data meta-analysis [Articolo su rivista]
Dajti, E.; Ravaioli, F.; Zykus, R.; Rautou, P. -E.; Elkrief, L.; Grgurevic, I.; Stefanescu, H.; Hirooka, M.; Fraquelli, M.; Rosselli, M.; Chang, P. E. J.; Piscaglia, F.; Reiberger, T.; Llop, E.; Mueller, S.; Marasco, G.; Berzigotti, A.; Colli, A.; Festi, D.; Colecchia, A.; Alemanni, L. V.; Vestito, A.; Renzulli, M.; Azzaroli, F.; Colecchia, L.; Castera, L.; Ronot, M.; Platon-Lupsor, M.; Nicoara-Farcau, O.; Ignat, M.; Hias, Y.; Fichera, A.; Ooi, C. C.; Borghi, A.; Bauer, D.; Semmler, G.; Mandorfer, M.; Calleja, J. L.; Elshaarawy, O.; Romagnoli, D.
abstract

Background: The diagnosis of clinically significant portal hypertension is crucial for prognosis and treatment guidance in patients with compensated advanced chronic liver disease (ACLD). Spleen stiffness measurement (SSM) might improve the non-invasive diagnosis of clinically significant portal hypertension, but previous studies have reported heterogeneous SSM cutoffs. We aimed to evaluate the accuracy of SSM and SSM-based algorithms in this setting. Methods: In this systematic review and individual patient data meta-analysis, we searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library from database inception to Dec 31, 2022, for articles, abstracts, and letters, with no restrictions on language. Cross-sectional studies reporting hepatic venous pressure gradient and SSM by different techniques (transient elastography; two-dimensional shear-wave elastography [2D-SWE]; point shear-wave elastography [p-SWE]) in adults (≥18 years) with compensated ACLD were eligible for inclusion. The main outcome was the diagnostic performance of two SSM-based algorithms, with the Baveno VII model as a reference, evaluating sensitivity and specificity, as well as summary negative predictive values (NPVs) and positive predictive values (PPVs). In the Baveno VII model, clinically significant portal hypertension was ruled out if patients had a liver stiffness measurement (LSM) of 15 kPa or less and a platelet count of 150 × 109 platelets per L or higher and ruled in if they had an LSM of greater than 25 kPa. The two SSM-based models combined these same cutoffs with additional criteria. In the Baveno VII-SSM single cutoff model, clinically significant portal hypertension was ruled out if at least two of the following were present: LSM of 15 kPa or less, platelet count of 150 × 109 platelets per L or higher, and SSM of 40 kPa or less; and ruled in if at least two were present: LSM of greater than 25 kPa, platelet count of less than 150 × 109 platelets per L, and SSM of greater than 40 kPa. The Baveno VII-SSM dual cutoff model used the same criteria, but with a cutoff of SSM of less than 21 kPa to rule out, and greater than 50 kPa to rule in, clinically significant portal hypertension. This study is registered with PROSPERO, CRD42019127164. Findings: Of the 44 records assessed for eligibility, 17 studies (with 1245 patients) were included in the meta-analysis. In the transient elastography cohort (n=600), the Baveno VII algorithm was validated for both ruling out (NPV 100%, 95% CI 64–100; sensitivity 100%, 95% CI 70–100) and ruling in (PPV 95%, 85–98; specificity 94%, 95% CI 87–97) clinically significant portal hypertension, but the proportion of patients with indeterminate results (grey zone) was 48% (95% CI 44–52); 57% (95% CI 52–62) of patients with clinically significant portal hypertension were included in the rule-in zone. The Baveno VII-SSM dual cutoff model had adequate NPV (98%, 95% CI 58–100; sensitivity 100%, 95% CI 91–100) and PPV (93%, 95% CI 84–97; specificity 89%, 95% CI 84–93), with 32% (95% CI 28–36) of patients in the grey zone; 76% (95% CI 72–80) of the patients with clinically significant portal hypertension were in the rule-in zone. The Baveno VII-SSM single cutoff model had a sensitivity of 93% (95% CI 85–97) and a NPV of 85% (95% CI 60–96) for ruling out, and a specificity of 86% (95% CI 80–91) and a PPV of 92% (95% CI 83–95) for ruling in, clinically significant portal hypertension. 88% (95% CI 84–91) of patients with clinically significant portal hypertension were included in the rule-in zone and 9% (95% CI 7–12) of patients were in the grey zone. In the 2D-SWE cohort (n=225), all three algorithms could safely rule in clinically significant portal hypertension with adequate PPV (≥90%), but NPV was inadequate for ruling out clinically significant portal hypertension. Insufficient data were available to evaluate the performance of SSM assessed by p-SWE. Heterogen

2023 - Associations between higher plasma ferritin and hepcidin levels with liver stiffness in patients with type 2 diabetes: An exploratory study [Articolo su rivista]
Mantovani, A.; Csermely, A.; Castagna, A.; Antinori, E.; Danese, E.; Zusi, C.; Sani, E.; Ravaioli, F.; Colecchia, A.; Maffeis, C.; Valenti, L.; Girelli, D.; Targher, G.
abstract

Background: Currently, there is no information about the association between circulating levels of ferritin and hepcidin and liver fibrosis in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods: We enrolled 153 patients with T2DM with no known liver diseases, who consecutively attended our diabetes outpatient service and who underwent liver ultrasonography and liver stiffness measurement (LSM) by vibration-controlled transient elastography (Fibroscan® for the non-invasive assessment of liver fibrosis). Plasma ferritin and hepcidin concentrations were measured with an electrochemiluminescence immunoassay and mass spectrometry-based assay, respectively. Results: After stratification of patients by LSM tertiles [1st tertile median LSM: 3.6 (interquartile range: 3.3-4.0) kPa, 2nd tertile: 5.3 (4.9-5.9) kPa and 3rd tertile: 7.9 (6.7-9.4) kPa], we found that plasma ferritin and hepcidin concentrations increased across LSM tertiles [median ferritin: 68.7 (interquartile range: 25.1-147) vs. 85.8 (48.3-139) vs. 111 (59.3-203) μg/L, p = 0.021; median hepcidin: 2.5 (1.1-5.2) vs. 4.4 (2.5-7.3) vs. 4.1 (1.9-6.8) nmol/L, p = 0.032]. After adjustment for age, sex, diabetes duration, waist circumference, haemoglobin A1c, HOMA-insulin resistance score, triglycerides, haemoglobin, presence of hepatic steatosis on ultrasonography and patatin-like phospholipase domain-containing-3 (PNPLA3) rs738409 genetic variant, higher plasma ferritin levels were associated with greater LSM values (adjusted-odds ratio 2.10, 95% confidence interval 1.23-3.57, p = 0.005). Higher plasma hepcidin levels were also associated with greater LSM values (adjusted-odds ratio 1.90, 95% confidence interval 1.15-3.13, p = 0.013). Conclusions: Higher levels of plasma ferritin and hepcidin were associated with greater NAFLD-related liver fibrosis (assessed by LSM) in patients with T2DM, even after adjustment for established cardiometabolic risk factors, diabetes-related variables and other potential confounders.

2023 - Creatine Supplementation to Improve Sarcopenia in Chronic Liver Disease: Facts and Perspectives [Articolo su rivista]
Casciola, R.; Leoni, L.; Cuffari, B.; Pecchini, M.; Menozzi, R.; Colecchia, A.; Ravaioli, F.
abstract

Creatine supplementation has been one of the most studied and useful ergogenic nutritional support for athletes to improve performance, strength, and muscular mass. Over time creatine has shown beneficial effects in several human disease conditions. This review aims to summarise the current evidence for creatine supplementation in advanced chronic liver disease and its complications, primarily in sarcopenic cirrhotic patients, because this condition is known to be associated with poor prognosis and outcomes. Although creatine supplementation in chronic liver disease seems to be barely investigated and not studied in human patients, its potential efficacy on chronic liver disease is indirectly highlighted in animal models of non-alcoholic fatty liver disease, bringing beneficial effects in the fatty liver. Similarly, encephalopathy and fatigue seem to have beneficial effects. Creatine supplementation has demonstrated effects in sarcopenia in the elderly with and without resistance training suggesting a potential role in improving this condition in patients with advanced chronic liver disease. Creatine supplementation could address several critical points of chronic liver disease and its complications. Further studies are needed to support the clinical burden of this hypothesis.

2023 - Diagnostic accuracy of FibroScan-AST (FAST) score for the non-invasive identification of patients with fibrotic non-alcoholic steatohepatitis: A systematic review and meta-analysis [Articolo su rivista]
Ravaioli, F.; Dajti, E.; Mantovani, A.; Newsome, P. N.; Targher, G.; Colecchia, A.
abstract

Objective A simple combined score with liver stiffness, controlled attenuation parameter and serum aspartate aminotransferase (AST), the FibroScan-AST (FAST) score, has been proposed to non-invasively identify patients with fibrotic non-alcoholic steatohepatitis (NASH). We performed a systematic review and meta-analysis of published studies to evaluate the overall diagnostic accuracy of the FAST score in identifying patients with fibrotic NASH. Design We systematically searched MEDLINE, Ovid Embase, Scopus and Cochrane Library electronic databases for full-text published articles in any language between 3 February 2020 and 30 April 2022. We included original articles that reported data for the calculation of sensitivity and specificity of the FAST score for identifying adult patients with fibrotic NASH adults, according to previously described rule-out (≤0.35) and rule-in (≥0.67) cut-offs. Results We included 12 observational studies for a total of 5835 participants with biopsy-confirmed non-alcoholic fatty liver disease. The pooled prevalence of fibrotic NASH was 28% (95% CI 21% to 34%). The FAST score's pooled sensitivity was 89% (95% CI 82% to 93%), and the pooled specificity was 89% (95% CI 83% to 94%) according to the aforementioned rule-in/rule-out cut-offs. The negative predictive value and positive predictive value of the FAST score were 92% (95% CI 91% to 95%) and 65% (95% CI 53% to 68%), respectively. Subgroup analyses and influential bias analyses did not alter these findings. Conclusion The results of our meta-analysis show that the FAST score has a good performance for non-invasive diagnosis of fibrotic NASH. Therefore, this score can be used to efficiently identify patients who should be referred for a conclusive liver biopsy and/or consideration for treatment with emerging pharmacotherapies. PROSPERO registration number CRD42022350945.

2023 - Feasibility, safety, and outcome of second-line nivolumab/bevacizumab in liver transplant patients with recurrent hepatocellular carcinoma [Articolo su rivista]
Di Marco, Lorenza; Pivetti, Alessandra; Foschi, Francesco Giuseppe; D'Amico, Roberto; Schepis, Filippo; Caporali, Cristian; Casari, Federico; Lasagni, Simone; Critelli, Rosina Maria; Milosa, Fabiola; Romanzi, Adriana; Marcelli, Gemma; De Maria, Nicola; Romagnoli, Dante; Catellani, Barbara; Scianò, Filippo; Magistri, Paolo; Colecchia, Antonio; Sighinolfi, Pamela; Di Benedetto, Fabrizio; Martinez-Chantar, Maria-Luz; Villa, Erica
abstract

2023 - From Listing to Recovery: A Review of Nutritional Status Assessment and Management in Liver Transplant Patients [Articolo su rivista]
Ravaioli, F.; De Maria, N.; Di Marco, L.; Pivetti, A.; Casciola, R.; Ceraso, C.; Frassanito, G.; Pambianco, M.; Pecchini, M.; Sicuro, C.; Leoni, L.; Di Sandro, S.; Magistri, P.; Menozzi, R.; Di Benedetto, F.; Colecchia, A.
abstract

Liver transplantation (LT) is a complex surgical procedure requiring thorough pre- and post-operative planning and care. The nutritional status of the patient before, during, and after LT is crucial to surgical success and long-term prognosis. This review aims to assess nutritional status assessment and management before, during, and after LT, with a focus on patients who have undergone bariatric surgery. We performed a comprehensive topic search on MEDLINE, Ovid, In-Process, Cochrane Library, EMBASE, and PubMed up to March 2023. It identifies key factors influencing the nutritional status of liver transplant patients, such as pre-existing malnutrition, the type and severity of liver disease, comorbidities, and immunosuppressive medications. The review highlights the importance of pre-operative nutritional assessment and intervention, close nutritional status monitoring, individualised nutrition care plans, and ongoing nutritional support and monitoring after LT. The review concludes by examining the effect of bariatric surgery on the nutritional status of liver transplant recipients. The review offers valuable insights into the challenges and opportunities for optimising nutritional status before, during, and after LT.

2023 - Hepatic encephalopathy increases the risk for mortality and hospital readmission in decompensated cirrhotic patients: a prospective multicenter study [Articolo su rivista]
Riggio, O.; Celsa, C.; Calvaruso, V.; Merli, M.; Caraceni, P.; Montagnese, S.; Mora, V.; Milana, M.; Saracco, G. M.; Raimondo, G.; Benedetti, A.; Burra, P.; Sacco, R.; Persico, M.; Schepis, F.; Villa, E.; Colecchia, A.; Fagiuoli, S.; Pirisi, M.; Barone, M.; Azzaroli, F.; Soardo, G.; Russello, M.; Morisco, F.; Labanca, S.; Fracanzani, A. L.; Pietrangelo, A.; Di Maria, G.; Nardelli, S.; Ridola, L.; Gasbarrini, A.; Camma, C.
abstract

Introduction: Hepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE. Methods: We prospectively enrolled 112 consecutive cirrhotic patients hospitalized for HE (HE group) at 25 Italian referral centers. A cohort of 256 patients hospitalized for decompensated cirrhosis without HE served as controls (no HE group). After hospitalization for HE, patients were followed-up for 12 months until death or liver transplant (LT). Results: During follow-up, 34 patients (30.4%) died and 15 patients (13.4%) underwent LT in the HE group, while 60 patients (23.4%) died and 50 patients (19.5%) underwent LT in the no HE group. In the whole cohort, age (HR 1.03, 95% CI 1.01–1.06), HE (HR 1.67, 95% CI 1.08–2.56), ascites (HR 2.56, 95% CI 1.55–4.23), and sodium levels (HR 0.94, 95% CI 0.90–0.99) were significant risk factors for mortality. In the HE group, ascites (HR 5.07, 95% CI 1.39–18.49) and BMI (HR 0.86, 95% CI 0.75–0.98) were risk factors for mortality, and HE recurrence was the first cause of hospital readmission. Conclusion: In patients hospitalized for decompensated cirrhosis, HE is an independent risk factor for mortality and the most common cause of hospital readmission compared with other decompensation events. Patients hospitalized for HE should be evaluated as candidates for LT.

2023 - Individual and population screening of varices needing treatment by a simple, safe and accurate test [Articolo su rivista]
Ravaioli, F.; Berger, A.; Farcau, O.; Colecchia, A.; Stefanescu, H.; Candillier, C.; Nahon, P.; Bureau, C.; Ganne-Carrie, N.; Berzigotti, A.; de Ledinghen, V.; Petta, S.; Cales, P
abstract

Background: Several tests have been developed to screen varices needing treatment (VNT) in different screening settings. We aimed to develop simple estimators to quantify VNT risk and spare endoscopy while missing <5% of VNT, adapted to different screenings in the main etiologies. Methods: 2,368 patients with chronic liver disease were included. The main VNT predictors were platelets, prothrombin index (PI) and LSM. Their interactions led to score construction, LIP: (LSM*45)/(PI*platelets), and BLIP: BMI-adjusted LIP in NAFLD. Scores were categorized either for population (VNT sensitivity ≥95%) or individual (negative predictive value ≥95%) VNT screening. Results: 1) Scores diagnosing VNT. AUROCs were, PLER: 0.767 Anticipate: 0.773 (p=0.059 vs previous), LIP: 0.779 (p=0.136), PLEASE: 0.789 (p=0.196). 2) Population screening performance was in increasing order (with missed VNT rate), Baveno6 criteria: 23.9% (2.5%), Anticipate: 24.5%, p=0.367 vs previous (3.3%), PLER: 27.3%, p<0.001 (3.6%), LIP: 33.4%, p<0.001 (4.2%), PLEASE: 35.2%, p=0.006 (3.6%). In NAFLD, LIP: 38.6%, BLIP: 40.8%, p=0.038. 3) Individual screening performance was, expanded Baveno6 criteria: 42.7%, LIP: 54.1%, p<0.001. In NAFLD, performance was, NAFLD-cirrhosis criteria: 66.7%, BLIP: 74.6%, p<0.001. Conclusion: LIP combined simplicity, performance and safety in each etiology. In NAFLD, BMI-adjusted LIP outperformed other tests.

2023 - Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model [Articolo su rivista]
Vizzutti, F.; Celsa, C.; Calvaruso, V.; Enea, M.; Battaglia, S.; Turco, L.; Senzolo, M.; Nardelli, S.; Miraglia, R.; Roccarina, D.; Campani, C.; Saltini, D.; Caporali, C.; Indulti, F.; Gitto, S.; Zanetto, A.; Di Maria, G.; Bianchini, M.; Pecchini, M.; Aspite, S.; Di Bonaventura, C.; Citone, M.; Guasconi, T.; Di Benedetto, F.; Arena, U.; Fanelli, F.; Maruzzelli, L.; Riggio, O.; Burra, P.; Colecchia, A.; Villa, E.; Marra, F.; Camma, C.; Schepis, F.
abstract

Background and Aims: Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in patients with cirrhosis with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (greater than or equal to 70 years) is debated, and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults. Approach and Results: We prospectively enrolled 411 consecutive patients observed at four referral centers with de novo TIPS implantation for refractory ascites or secondary prophylaxis of variceal bleeding (derivation cohort) and an external cohort of 415 patients with similar indications for TIPS (validation cohort). Older adult patients in the two cohorts were 99 and 76, respectively. A cause-specific Cox competing risks model was used to predict liver-related mortality, with orthotopic liver transplant and death for extrahepatic causes as competing events. Age, alcoholic etiology, creatinine levels, and international normalized ratio in the overall cohort, and creatinine and sodium levels in older adults were independent risk factors for liver-related death by multivariable analysis. Conclusions: After TIPS implantation, mortality is increased by aging, but TIPS placement should not be precluded in patients older than 70 years. In older adults, creatinine and sodium levels are useful predictors for decision making. Further efforts to update the prediction model with larger sample size are warranted.

2023 - Oesophageal varices predict complications in compensated advanced non-alcoholic fatty liver disease [Articolo su rivista]
Pennisi, G.; Enea, M.; Vigano, M.; Schepis, F.; de Ledinghen, V.; Berzigotti, A.; Wai-Sun Wong, V.; Fracanzani, A. L.; Sebastiani, G.; Lara-Romero, C.; Bugianesi, E.; Svegliati-Baroni, G.; Marra, F.; Aghemo, A.; Valenti, L.; Calvaruso, V.; Colecchia, A.; Di Maria, G.; La Mantia, C.; Lin, H.; Mendoza, Y. P.; Pugliese, N.; Ravaioli, F.; Romero-Gomez, M.; Saltini, D.; Craxi, A.; Di Marco, V.; Camma, C.; Petta, S.
abstract

Background & Aims: We aimed to evaluate the impact of oesophageal varices (OV) and their evolution on the risk of complications of compensated advanced chronic liver disease (cACLD) caused by non-alcoholic fatty liver disease (NAFLD). We also assessed the accuracy of non-invasive scores for predicting the development of complications and for identifying patients at low risk of high-risk OV. Methods: We performed a retrospective assessment of 629 patients with NAFLD-related cACLD who had baseline and follow-up oesophagogastroduodenoscopy and clinical follow-up to record decompensation, portal vein thrombosis (PVT), and hepatocellular carcinoma. Results: Small and large OV were observed at baseline in 30 and 15.9% of patients, respectively. The 4-year incidence of OV from absence at baseline, and that of progression from small to large OV were 16.3 and 22.4%, respectively. Diabetes and a ≥5% increase in BMI were associated with OV progression. Multivariate Cox regression revealed that small (hazard ratio [HR] 2.24, 95% CI 1.47–3.41) and large (HR 3.86, 95% CI 2.34–6.39) OV were independently associated with decompensation. When considering OV status and trajectories, small (HR 2.65, 95% CI 1.39–5.05) and large (HR 4.90, 95% CI 2.49–9.63) OV at baseline and/or follow-up were independently associated with decompensation compared with the absence of OV at baseline and/or follow-up. The presence of either small (HR 2.8, 95% CI 1.16–6.74) or large (HR 5.29, 95% CI 1.96–14.2) OV was also independently associated with incident PVT. Conclusion: In NAFLD-related cACLD, the presence, severity, and evolution of OV stratify the risk of developing decompensation and PVT. Impact and implications: Portal hypertension is the main driver of liver decompensation in chronic liver diseases, and its non-invasive markers can help risk prediction. The presence, severity, and progression of oesophageal varices stratify the risk of complications of non-alcoholic fatty liver disease. Easily obtainable laboratory values and liver stiffness measurement can identify patients at low risk for whom endoscopy may be withheld, and can also stratify the risk of liver-related complications.

2023 - Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease [Articolo su rivista]
Musio, A.; Perazza, F.; Leoni, L.; Stefanini, B.; Dajti, E.; Menozzi, R.; Petroni, M. L.; Colecchia, A.; Ravaioli, F.
abstract

Chronic liver disease (CLD), including non-alcoholic fatty liver disease (NAFLD) and its advanced form, non-alcoholic steatohepatitis (NASH), affects a significant portion of the population worldwide. NAFLD is characterised by fat accumulation in the liver, while NASH is associated with inflammation and liver damage. Osteosarcopenia, which combines muscle and bone mass loss, is an emerging clinical problem in chronic liver disease that is often underappreciated. The reductions in muscle and bone mass share several common pathophysiological pathways; insulin resistance and chronic systemic inflammation are the most crucial predisposing factors and are related to the presence and gravity of NAFLD and to the worsening of the outcome of liver disease. This article explores the relationship between osteosarcopenia and NAFLD/MAFLD, focusing on the diagnosis, prevention and treatment of this condition in patients with CLD.

2023 - Pneumocystis jirovecii pneumonia in patients with decompensated cirrhosis: a case series [Articolo su rivista]
Franceschini, Erica; Dolci, Giovanni; Santoro, Antonella; Meschiari, Marianna; Riccò, Alice; Menozzi, Marianna; Burastero, Giulia Jole; Cuffari, Biagio; De Maria, Nicola; Serio, Lucia; Biagioni, Emanuela; Catellani, Barbara; Sandro, Stefano Di; Colecchia, Antonio; Girardis, Massimo; Benedetto, Fabrizio Di; Mussini, Cristina
abstract

Objectives: Pneumocystis jirovecii pneumonia (PCP) incidence is increasing in people without HIV. Decompensated liver cirrhosis is not currently considered a risk factor for PCP. The aim of this paper is to describe a case series of patients with decompensated liver cirrhosis and PCP. Methods: All consecutive patients hospitalized with decompensated cirrhosis and microbiology-confirmed PCP at Policlinico Modena University Hospital from January 1, 2016 to December 31, 2021 were included in our series. Results: Eight patients were included. All patients had advanced-stage liver disease with a model for end-stage liver disease score above 15 (6/8 above 20). Four were on an active orthotopic liver transplant waiting list at the time of PCP diagnosis. Five patients did not have any traditional risk factor for PCP, whereas the other three were on glucocorticoid treatment for acute-on-chronic liver failure. All patients were treated with cotrimoxazole, except two who died before the diagnosis. Five patients died (62.5%), four of them within 30 days from PCP diagnosis. Of the remaining three, one patient underwent liver transplantation. Conclusion: Although further studies are needed, liver cirrhosis can be an independent risk factor for PCP in patients with decompensated cirrhosis that is mainly due to severe alcoholic hepatitis and who are on corticosteroids therapy, and primary prophylaxis for PCP should be considered.

2023 - Post COVID-19 irritable bowel syndrome [Articolo su rivista]
Marasco, Giovanni; Cremon, Cesare; Barbaro, Maria Raffaella; Cacciari, Giulia; Falangone, Francesca; Kagramanova, Anna; Bordin, Dmitry; Drug, Vasile; Miftode, Egidia; Fusaroli, Pietro; Mohamed, Salem Youssef; Ricci, Chiara; Bellini, Massimo; Rahman, Mohammed Masudur; Melcarne, Luigi; Santos, Javier; Lobo, Beatriz; Bor, Serhat; Yapali, Suna; Akyol, Deniz; Sapmaz, Ferdane Pirincci; Urun, Yonca Yilmaz; Eskazan, Tugce; Celebi, Altay; Kacmaz, Huseyin; Ebik, Berat; Binicier, Hatice Cilem; Bugdayci, Mehmet Sait; Yağcı, Munkhtsetseg Banzragch; Pullukcu, Husnu; Kaya, Berrin Yalınbas; Tureyen, Ali; Hatemi, İbrahim; Koc, Elif Sitre; Sirin, Goktug; Calıskan, Ali Riza; Bengi, Goksel; Alıs, Esra Ergun; Lukic, Snezana; Trajkovska, Meri; Hod, Keren; Dumitrascu, Dan; Pietrangelo, Antonello; Corradini, Elena; Simren, Magnus; Sjölund, Jessica; Tornkvist, Navkiran; Ghoshal, Uday C; Kolokolnikova, Olga; Colecchia, Antonio; Serra, Jordi; Maconi, Giovanni; De Giorgio, Roberto; Danese, Silvio; Portincasa, Piero; Di Sabatino, Antonio; Maggio, Marcello; Philippou, Elena; Lee, Yeong Yeh; Salvi, Daniele; Venturi, Alessandro; Borghi, Claudio; Zoli, Marco; Gionchetti, Paolo; Viale, Pierluigi; Stanghellini, Vincenzo; Barbara, Giovanni
abstract

Objectives: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. Design: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. Results: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. Conclusion: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. Trial registration number: NCT04691895.

2023 - Reply [Articolo su rivista]
Vizzutti, F.; Celsa, C.; Battaglia, S.; Miraglia, R.; Enea, M.; Marra, F.; Colecchia, A.; Camma, C.; Schepis, F.
abstract

2023 - Splenomegaly in patients with primary or secondary myelofibrosis who are candidates for allogeneic hematopoietic cell transplantation: a Position Paper on behalf of the Chronic Malignancies Working Party of the EBMT [Articolo su rivista]
Polverelli, N.; Hernandez-Boluda, J. C.; Czerw, T.; Barbui, T.; D'Adda, M.; Deeg, H. J.; Ditschkowski, M.; Harrison, C.; Kroger, N. M.; Mesa, R.; Passamonti, F.; Palandri, F.; Pemmaraju, N.; Popat, U.; Rondelli, D.; Vannucchi, A. M.; Verstovsek, S.; Robin, M.; Colecchia, A.; Grazioli, L.; Damiani, E.; Russo, D.; Brady, J.; Patch, D.; Blamek, S.; Damaj, G. L.; Hayden, P.; Mclornan, D. P.; Yakoub-Agha, I.
abstract

: Splenomegaly is a hallmark of myelofibrosis, a debilitating haematological malignancy for which the only curative option is allogeneic haematopoietic cell transplantation (HCT). Considerable splenic enlargement might be associated with a higher risk of delayed engraftment and graft failure, increased non-relapse mortality, and worse overall survival after HCT as compared with patients without significantly enlarged splenomegaly. Currently, there are no standardised guidelines to assist transplantation physicians in deciding optimal management of splenomegaly before HCT. Therefore, the aim of this Position Paper is to offer a shared position statement on this issue. An international group of haematologists, transplantation physicians, gastroenterologists, surgeons, radiotherapists, and radiologists with experience in the treatment of myelofibrosis contributed to this Position Paper. The key issues addressed by this group included the assessment, prevalence, and clinical significance of splenomegaly, and the need for a therapeutic intervention before HCT for the control of splenomegaly. Specific scenarios, including splanchnic vein thrombosis and COVID-19, are also discussed. All patients with myelofibrosis must have their spleen size assessed before allogeneic HCT. Myelofibrosis patients with splenomegaly measuring 5 cm and larger, particularly when exceeding 15 cm below the left costal margin, or with splenomegaly-related symptoms, could benefit from treatment with the aim of reducing the spleen size before HCT. In the absence of, or loss of, response, patients with increasing spleen size should be evaluated for second-line options, depending on availability, patient fitness, and centre experience. Splanchnic vein thrombosis is not an absolute contraindication for HCT, but a multidisciplinary approach is warranted. Finally, prevention and treatment of COVID-19 should adhere to standard recommendations for immunocompromised patients.

2023 - The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients [Articolo su rivista]
Rendina, M.; Barone, M.; Lillo, C.; Trapani, S.; Masiero, L.; Trerotoli, P.; Puoti, F.; Lupo, L. G.; Tandoi, F.; Agnes, S.; Grieco, A.; Andorno, E.; Marenco, S.; Giannini, E. G.; Baccarani, U.; Toniutto, P.; Carraro, A.; Colecchia, A.; Cescon, M.; Morelli, M. C.; Cillo, U.; Burra, P.; Angeli, P.; Colledan, M.; Fagiuoli, S.; De Carlis, L.; Belli, L.; De Simone, P.; Carrai, P.; Di Benedetto, F.; De Maria, N.; Ettorre, G. M.; Giannelli, V.; Gruttadauria, S.; Volpes, R.; Corsale, S.; Mazzaferro, V.; Bhoori, S.; Romagnoli, R.; Martini, S.; Rossi, G.; Caccamo, L.; Donato, M. F.; Rossi, M.; Ginanni Corradini, S.; Spada, M.; Maggiore, G.; Tisone, G.; Lenci, I.; Vennarecci, G.; Tortora, R.; Vivarelli, M.; Svegliati Baroni, G.; Zamboni, F.; Mameli, L.; Tafuri, S.; Simone, S.; Gesualdo, L.; Cardillo, M.; Di Leo, A.
abstract

Introduction: The study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators. Methods: Case collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate. Results: Among the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP. Discussion: According to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different from NL-SOTRs, probably related to the ability of the grafted liver to induce immunotolerance.

2023 - The management of endoscopic retrograde cholangiopancreatography related infections risk: results of an italian survey at regional level [Articolo su rivista]
Cennamo, V.; Landi, S.; Aragona, G.; Colecchia, A.; Conigliaro, R.; Di Lorenzo, D.; Di Marco, M.; Fabbri, C.; Falcone, P.; Gaiani, F.; Manno, M.; Merighi, A.; Mussetto, A.; Peghetti, A.; Sassateli, R.; Solfrini, V.; Zagari, R. M.; Arena, R.; Bertani, H.; Binda, C.; Boarino, V.; De Padova, A.; Feletti, V.; Fuccio, L.; Iori, V.; Nervi, G.; Prati, G. M.; Soriani, P.; De Palma, R.
abstract

Background and aim. Among the Endoscopic retrograde cholangiopancreatography (ERCP) adverse events, an increasingly arising problem is the transmission of Multi Drug Resistant (MDR) Bacteria through duodenoscopes. The aim of this survey was to evaluate the current clinical practice of management of ERCP associated infections in Emilia-Romagna, Italy.Methods. An online survey was developed including 12 questions on management of ERCP associated infections risk. The survey was proposed to all 12 endoscopy centers in Emilia Romagna that perform at least > 200 ERCPs per year. Results. 11 centers completed the survey (92%). Among all risk factors of ERCP infections, hospitalization in intensive care units, immunosuppressant therapies, and previous MDR infections have achieved a 80 % minimum of concurrence by our respondents. The majority of them did not have a formalized document in their hospital describing categories and risk factors helpful in the detection of patients undergoing ERCP with an high-level infective risk (9/11, 82%). Most centers (8/11, 72%) do not perform screening in patients at risk of ERCP infections. Post procedural monitoring is performed by 6 of 11 centers (55%). Conclusion. Our survey showed that, at least at regional level, there is a lack of procedures and protocols related to the management of patients at risk of ERCP infections.

2023 - Trends in chronic hepatitis B virus infection in Italy over a 10-year period: Clues from the nationwide PITER and MASTER cohorts toward elimination [Articolo su rivista]
Brancaccio, G.; Coco, B.; Nardi, A.; Quaranta, M. G.; Tosti, M. E.; Ferrigno, L.; Cacciola, I.; Messina, V.; Chessa, L.; Morisco, F.; Milella, M.; Barbaro, F.; Ciancio, A.; Russo, F. P.; Coppola, N.; Blanc, P.; Claar, E.; Verucchi, G.; Puoti, M.; Zignego, A. L.; Chemello, L.; Madonia, S.; Fagiuoli, S.; Marzano, A.; Ferrari, C.; Lampertico, P.; Di Marco, V.; Craxì, A.; Santantonio, T. A.; Raimondo, G.; Brunetto, M. R.; Gaeta, G. B.; Kondili, L. A.; Pasulo, L.; Coppola, C.; Pisano, F.; Romano, M.; Porcu, C.; Bottalico, I. F.; Cossiga, V.; Tata, X.; Sagnelli, C.; Pierotti, P.; Degasperi, E.; Rosato, V.; Badia, L.; Ieluzzi, D.; Monti, M.; Bavetta, M. G.; Cavalletto, L.; Toniutto, P.; Fornasiere, E.; Colecchia, A.; Ferrarese, A.; Nardone, G.; Rocco, A.; Viganò, M.; Foschi, F. G.; Conti, F.; Morsica, G.; Salpietro, S.; Torti, C.; Costa, C.; Federico, A.; Dallio, M.; Giorgini, A.; Anselmo, M.; De Leo, P.; Zaltron, S.; Cambianica, A.; Piscaglia, F.; Serio, I.; Schivazappa, S.; Mastroianni, A.; Chidichimo, L.; Massari, M.; Mazzaro, C.; Marrone, A.; D'Amore, F. M.; D'Offizi, G.; Licata, A.; Niro, G. A.; Pollicino, T.; Aghemo, A.
abstract

Objectives: The study measures trends in the profile of patients with chronic hepatitis B virus linked to care in Italy.Methods: A cross-sectional, multicenter, observational cohort (PITER cohort) of consecutive patients with hepatitis B surface antigen (HBsAg) over the period 2019-2021 from 46 centers was evaluated. The ref-erence was the MASTER cohort collected over the years 2012-2015. Standard statistical methods were used.Results: The PITER cohort enrolled 4583 patients, of whom 21.8% were non-Italian natives. Compared with those in MASTER, the patients were older and more often female. The prevalence of hepatitis B e antigen (HBeAg) declined (7.2% vs 12.3; P < 0.0 0 01) and that of anti-hepatitis D virus (HDV) remained stable (9.3% vs 8.3%). In both cohorts, about 25% of the patients had cirrhosis, and those in the PITER cohort were older. HBeAg-positive was 5.0% vs 12.6% ( P < 0.0 0 01) and anti-HDV positive 24.8% vs 17.5% ( P < 0.0017). In the logistic model, the variables associated with cirrhosis were anti-HDV-positive (odds ratio = 10.08; confidence interval 7.63-13.43), age, sex, and body mass index; the likelihood of cirrhosis was reduced by 40% in the PITER cohort. Among non-Italians, 12.3% were HBeAg-positive (vs 23.4% in the MASTER cohort; P < 0.0 0 01), and 12.3% were anti-HDV-positive (vs 11.1%). Overall, the adherence to the European Association for the Study of the Liver recommendations for antiviral treatment increased over time.Conclusion: Chronic hepatitis B virus infection appears to be in the process of becoming under control in Italy; however, HDV infection is still a health concern in patients with cirrhosis and in migrants.(c) 2023 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

2023 - Unlocking the Power of Late-Evening Snacks: Practical Ready-to-Prescribe Chart Menu for Patients with Cirrhosis [Articolo su rivista]
Leoni, Laura; Valoriani, Filippo; Barbieri, Riccardo; Pambianco, Martina; Vinciguerra, Martina; Sicuro, Chiara; Colecchia, Antonio; Menozzi, Renata; Ravaioli, Federico
abstract

: The efficacy of the late-evening snack (LES) has been extensively studied due to the impact of the longest intermeal duration occurring at night in patients with cirrhosis. While actual clinical guidelines on nutrition in chronic liver disease recommend an LES, no specific nutritional compositions have been reported by the European Association for the Study of the Liver (EASL) and the European Society for Clinical Nutrition and Metabolism (ESPEN). Late-evening snacks vary greatly among studies, including natural foods and/or nutritional supplements, yet oral supplements still need to fully meet the LES's nutritional composition. In addition, many hepatologists need to gain experience in nutritional approaches and have access to registered dieticians who can help them manage patients with liver disease. Therefore, this review study aims to summarise evidence regarding using LESs and the mechanisms behind long starvation in patients with cirrhosis. It also provides a practical nutritional guide with several LES options based on common natural foods tailored to special patients' nutritional requirements and geographical backgrounds. In preventing accelerated starvation and related protein malnutrition and sarcopenia in patients with cirrhosis, the nutritional composition of LESs is essential. The proper and straightforward application of the LES's rational nutrition is an advantage to cirrhotic patients and should be carried out by healthcare professionals to enhance the overall liver function and nutritional status of patients with cirrhosis.

2022 - A Combined Baveno VII and Spleen Stiffness Algorithm to Improve the Noninvasive Diagnosis of Clinically Significant Portal Hypertension in Patients With Compensated Advanced Chronic Liver Disease [Articolo su rivista]
Dajti, E.; Ravaioli, F.; Marasco, G.; Alemanni, L. V.; Colecchia, L.; Ferrarese, A.; Cusumano, C.; Gemini, S.; Vestito, A.; Renzulli, M.; Golfieri, R.; Festi, D.; Colecchia, A.
abstract

INTRODUCTION:A noninvasive diagnosis of clinically significant portal hypertension (CSPH) has important prognostic and therapeutic implications for patients with compensated advanced chronic liver disease. We aimed to validate and improve the available algorithms for the CSPH diagnosis by evaluating spleen stiffness measurement (SSM) in patients with compensated advanced chronic liver disease.METHODS:This is a retrospective study including patients with liver stiffness measurement (LSM) ≥10 kPa, no previous decompensation, and available measurements of hepatic venous pressure gradient, LSM, and SSM by transient elastography referring to our center in Bologna. The diagnostic algorithms were adequate if negative and positive predictive values were >90% when ruling out and ruling in CSPH, respectively; these models were validated in a cohort from Verona. The 5-year decompensation rate was reported.RESULTS:One hundred fourteen patients were included in the derivation cohort. The Baveno VII diagnostic algorithm (LSM ≤15 kPa + platelet count ≥150 × 109/L to rule out CSPH and LSM >25 kPa to rule in CSPH) was validated; however, 40%-60% of the patients remained in the gray zone. The addition of SSM (40 kPa) to the model significantly reduced the gray zone to 7%-15%, maintaining adequate negative and positive predictive values. The diagnostic algorithms were validated in a cohort of 81 patients from Verona. All first decompensation events occurred in the "rule-in" zone of the model including SSM.DISCUSSION:The addition of SSM significantly improves the clinical applicability of the algorithm based on LSM and platelet count for CSPH diagnosis. Our models can be used to noninvasively identify candidates for nonselective beta-blocker treatment and patients at a high risk of decompensation.

2022 - Assessment of liver stiffness measurement and ultrasound findings change during inotuzumab ozogamicin cycles for relapsed or refractory acute lymphoblastic leukemia [Articolo su rivista]
Ravaioli, F.; Marconi, G.; Martinelli, G.; Dajti, E.; Sartor, C.; Abbenante, M. C.; Alemanni, L. V.; Nanni, J.; Rossini, B.; Parisi, S.; Colecchia, L.; Cristiano, G.; Marasco, G.; Vestito, A.; Paolini, S.; Bonifazi, F.; Curti, A.; Festi, D.; Cavo, M.; Colecchia, A.; Papayannidis, C.
abstract

In adult patients, acute lymphoblastic leukemia (ALL) is a rare hematological cancer with a cure rate below 50% and frequent relapses. With traditional therapies, patients with relapsed or refractory (R/R) ALL have a survival that may be measured in months; in these patients, inotuzumab ozogamicin (IO) is an effective therapy. IO was linked to increased risk of veno-occlusive disease/sinusoid obstruction syndrome (VOD/SOS), liver injury, and various grade of liver-related complications during clinical trials and real-life settings; however, hepatologic monitoring protocol is not established in this population. In our institution, 21 patients who received IO (median of 6 doses of IO administered) for R/R ALL were prospectively followed for hepatologic surveillance, including clinical evaluation, ultrasonography, and liver stiffness measurement (LSM) biochemistry. After a median follow-up of 17.2 months, two SOS events were reported (both after allogeneic transplant) as IO potentially related clinically relevant adverse event. Mild alterations were reported in almost the totality of patients and moderate-severe liver biochemical alterations in a quarter of patients. Within biochemicals value, AST and ALP showed an augment related to IO administration. LSM linearly augmented for each IO course administered. Baseline LSM was related to liver-related changes, especially with the severity of portal hypertension (PH)-related complications. Pre-transplant LSM was higher in patients receiving IO when compared with a control cohort. PH-related complications were discovered in nearly 77% of patients, with clinically significant PH occurrence and development of ascites in 38% and 14%, respectively. This prospective experience constitutes the rationale to design a hepatologic monitoring program in patients receiving IO. LSM may be of pivotal importance in this program, constituting a rapid and effective screening that quantitatively correlates with liver alterations.

2022 - Association between lower plasma adiponectin levels and higher liver stiffness in type 2 diabetic individuals with nonalcoholic fatty liver disease: an observational cross-sectional study [Articolo su rivista]
Mantovani, A.; Zusi, C.; Csermely, A.; Salvagno, G. L.; Colecchia, A.; Lippi, G.; Maffeis, C.; Targher, G.
abstract

Purpose: Little is known about the association between plasma adiponectin levels and nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). We examined whether there is an association between lower plasma adiponectin levels and the presence/severity of NAFLD in people with T2DM. Methods: We cross-sectionally recruited 79 men with non-insulin-treated T2DM and no known liver diseases, who had consecutively attended our diabetes outpatient service over a 6-month period and who underwent both ultrasonography and Fibroscan-measured liver stiffness (LSM). Nine single nucleotide polymorphisms (PNPLA3 rs738409 and other genetic variants) associated with NAFLD were investigated. Results: Among the 79 participants included (mean age 67 ± 10 years, BMI 27.7 ± 4 kg/m2), 28 did not have NAFLD, 32 had steatosis alone, and 19 had NAFLD with coexisting significant fibrosis (LSM ≥ 7.0 kPa by Fibroscan®). Compared to those without NAFLD, patients with hepatic steatosis alone and those with hepatic steatosis and coexisting significant fibrosis had lower high-molecular-weight adiponectin levels (5.5 [IQR 2.3–7.6] vs. 2.4 [1.8–3.7] vs. 1.6 [1.0–2.9] µg/mL; p < 0.001). After adjustment for age, body mass index, insulin resistance, and the PNPLA3 rs738409 variant, lower plasma adiponectin levels were found to be associated with increased odds of both steatosis alone (adjusted-odds ratio [OR] 2.44, 95% CI 1.04–5.56, p = 0.042) and NAFLD with coexisting significant fibrosis (adjusted-OR 3.84, 95% CI 1.23–10.0, p = 0.020). Similar findings were observed after adjustment for the other eight genotyped NAFLD-related polymorphisms. Conclusion: Lower plasma adiponectin levels are closely associated with the presence and severity of NAFLD in men with T2DM, pointing to a role of adiponectin in NAFLD development and progression.

2022 - Endothelial angiopoietin-2 overexpression in explanted livers identifies subjects at higher risk of recurrence of hepatocellular carcinoma after liver transplantation [Articolo su rivista]
Lasagni, Simone; Leonardi, Filippo; Pivetti, Alessandra; Di Marco, Lorenza; Ravaioli, Federico; Serenari, Matteo; Gitto, Stefano; Critelli, Rosina Maria; Milosa, Fabiola; Romanzi, Adriana; Mancarella, Serena; Dituri, Francesco; Riefolo, Mattia; Catellani, Barbara; Magistri, Paolo; Romagnoli, Dante; Celsa, Ciro; Enea, Marco; de Maria, Nicola; Schepis, Filippo; Colecchia, Antonio; Cammà, Calogero; Cescon, Matteo; D'Errico, Antonietta; di Benedetto, Fabrizio; Giannelli, Gianluigi; Martinez-Chantar, Maria Luz; Villa, Erica
abstract

Background Though the precise criteria for accessing LT are consistently being applied, HCC recurrence (HCC-R_LT) still affects more than 15% of the patients. We analyzed the clinical, histopathological, and biological features of patients with HCC to identify the predictive factors associated with cancer recurrence and survival after LT.Methods We retrospectively analyzed 441 patients with HCC who underwent LT in our center. Overall, 70 (15.8%) of them developed HCC-R_LT. We matched them by age at transplant and etiology with 70 non-recurrent patients. A comparable cohort from the Liver Transplant Centre of Bologna served as validation. The clinical and biochemical characteristics and pre-LT criteria (Milan, Metroticket, Metroticket_AFP, and AFP model) were evaluated. Histological analysis and immunohistochemistry for angiopoietin-2 in the tumor and non-tumor tissue of explanted livers were performed. Patients' follow-up was until death, last clinical evaluation, or 31 December 2021. In patients with HCC-R_LT, the date of diagnosis of recurrence and anatomical site has been reported; if a biopsy of recurrence was available, histologic and immunohistochemical analyses were also performed.Results Patients were followed up for a mean period of 62.7 54.7 months (median, 39 months). A higher risk of HCC-R_LT was evident for factors related indirectly (AFP) or directly (endothelial angiopoietin-2, microvascular invasion) to biological HCC aggressiveness. In multivariate analysis, only angiopoietin-2 expression was independently associated with recurrence. Extremely high levels of endothelial angiopoietin-2 expression were also found in hepatic recurrence and all different metastatic locations. In univariate analysis, MELD, Metroticket_AFP Score, Edmondson-Steiner grade, microvascular invasion, and endothelial angiopoietin-2 were significantly related to survival. In multivariate analysis, angiopoietin-2 expression, Metroticket_AFP score, and MELD (in both training and validation cohorts) independently predicted mortality. In time-dependent area under receiver operating characteristic curve analysis, the endothelial angiopoietin-2 expression had the highest specificity and sensitivity for recurrence (AUC 0.922, 95% CI 0.876-0.962, p < 0.0001).Conclusions Endothelial angiopoietin-2 expression is a powerful independent predictor of post-LT tumor recurrence and mortality, highlighting the fundamental role of tumor biology in defining the patients' prognosis after liver transplantation. The great advantage of endothelial angiopoietin-2 is that it is evaluable in HCC biopsy before LT and could drive a patient's priority on the waiting list.

2022 - Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study [Articolo su rivista]
Marasco, Giovanni; Cremon, Cesare; Barbaro, Maria Raffaella; Salvi, Daniele; Cacciari, Giulia; Kagramanova, Anna; Bordin, Dmitry; Drug, Vasile; Miftode, Edgidia; Fusaroli, Pietro; Mohamed, Salem Youssef; Ricci, Chiara; Bellini, Massimo; Rahman, M Masudur; Melcarne, Luigi; Santos, Javier; Lobo, Beatriz; Bor, Serhat; Yapali, Suna; Akyol, Deniz; Sapmaz, Ferdane Pirincci; Urun, Yonca Yilmaz; Eskazan, Tugce; Celebi, Altay; Kacmaz, Huseyin; Ebik, Berat; Binicier, Hatice Cilem; Bugdayci, Mehmet Sait; Yağcı, Munkhtsetseg Banzragch; Pullukcu, Husnu; Kaya, Berrin Yalınbas; Tureyen, Ali; Hatemi, İbrahim; Koc, Elif Sitre; Sirin, Goktug; Calıskan, Ali Riza; Bengi, Goksel; Alıs, Esra Ergun; Lukic, Snezana; Trajkovska, Meri; Hod, Keren; Dumitrascu, Dan; Pietrangelo, Antonello; Corradini, Elena; Simren, Magnus; Sjolund, Jessica; Tornkvist, Navkiran; Ghoshal, Uday C; Kolokolnikova, Olga; Colecchia, Antonio; Serra, Jordi; Maconi, Giovanni; De Giorgio, Roberto; Danese, Silvio; Portincasa, Pietro; Di Stefano, Michele; Maggio, Marcello; Philippou, Elena; Lee, Yeong Yeh; Venturi, Alessandro; Borghi, Claudio; Zoli, Marco; Gionchetti, Paolo; Viale, Pierluigi; Stanghellini, Vincenzo; Barbara, Giovanni
abstract

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: TheGI-COVID-19 is a prospective,multicenter, controlled study. Patientswith and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID1and 296 COVID2) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection.

2022 - Reply to: Triple-phase CT scan for disease progression prediction in cirrhosis: A valid repurpose? [Articolo su rivista]
Dajti, E.; Colecchia, A.; Brandi, N.; Golfieri, R.; Renzulli, M.
abstract

2022 - Role of Vitamin D in Liver Disease and Complications of Advanced Chronic Liver Disease [Articolo su rivista]
Federico, Ravaioli; Pivetti, Alessandra; DI MARCO, Lorenza; Christou, Chrysanthi; Frassanito, Gabriella; Pambianco, Martina; Sicuro, Chiara; Gualandi, Noemi; Guasconi, Tomas; Pecchini, Maddalena; Colecchia, Antonio
abstract

Vitamin D is a crucial nutrient with many pleiotropic effects on health and various chronic diseases. The purpose of this review is to provide a detailed report on the pathophysiological mechanisms underlying vitamin D deficiency in patients with chronic liver disease, addressing the different liver etiologies and the condition of advanced chronic liver disease (cirrhosis) with related complications. To date, patients with liver disease, regardless of underlying etiology, have been shown to have reduced levels of vitamin D. There is also evidence of the predictive role of vitamin D values in complications and progression of advanced disease. However, specific indications of vitamin D supplementation are not conclusive concerning what is already recommended in the general population. Future studies should make an effort to unify and validate the role of vitamin D supplementation in chronic liver disease.

2022 - Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis [Articolo su rivista]
Marasco, G.; Dajti, E.; Serenari, M.; Alemanni, L. V.; Ravaioli, F.; Ravaioli, M.; Vestito, A.; Vara, G.; Festi, D.; Golfieri, R.; Cescon, M.; Renzulli, M.; Colecchia, A.
abstract

The burden of post-operative complications of patients undergoing liver resection for hepatocellular carcinoma (HCC) is a cause of morbidity and mortality. Recently, sarcopenia has been reported to influence the outcome of patients with cirrhosis. We aimed to assess factors associated with sarcopenia and its prognostic role in liver surgery candidates. We included all patients with compensated advanced chronic liver disease (cACLD) undergoing liver resection for primary HCC consecutively referred to the University of Bologna from 2014 to 2019 with an available preoperative abdominal CT-scan performed within the previous three months. A total of 159 patients were included. The median age was 68 years, and 80.5% of the patients were male. Sarcopenia was present in 82 patients (51.6%). Age and body mass index (BMI) were associated with the presence of sarcopenia at multivariate analysis. Thirteen (8.2%) patients developed major complications and 14 (8.9%) presented PHLF grade B-C. The model for end-stage liver disease score was associated with the development of major complications, whereas cACLD presence, thrombocytopenia, portal hypertension (PH), Child-Pugh score and Albumin-Bilirubin score were found to be predictors of clinically significative PHLF. The rate of major complications was 11.8% in sarcopenic patients with cACLD compared with no complications (0%) in patients without sarcopenia and cACLD (p = 0.032). The rate of major complications was significantly higher in patients with (16.3%) vs. patients without (0%) sarcopenia (p = 0.012) in patients with PH. In conclusion, sarcopenia, which is associated with age and BMI, may improve the risk stratification of post-hepatectomy major complications in patients with cACLD and PH.

2022 - Segmental Distribution of Hepatocellular Carcinoma in Cirrhotic Livers [Articolo su rivista]
Renzulli, M.; Brandi, N.; Pecorelli, A.; Pastore, L. V.; Granito, A.; Martinese, G.; Tovoli, F.; Simonetti, M.; Dajti, E.; Colecchia, A.; Golfieri, R.
abstract

Background: To evaluate the segmental distribution of hepatocellular carcinoma (HCC) according to Couinaud’s anatomical division in cirrhotic patients. Methods: Between 2020 and 2021, a total of 322 HCC nodules were diagnosed in 217 cirrhotic patients who underwent computed tomography (CT) or magnetic resonance imaging (MRI) for the evaluation of suspicious nodules (>1 cm) detected during ultrasound surveillance. For each patient, the segmental position of the HCC nodule was recorded according to Couinaud’s description. The clinical data and nodule characteristics were collected. Results: A total of 234 (72.7%) HCC nodules were situated in the right lobe whereas 79 (24.5%) were detected in the left lobe (p < 0.0001) and only 9 nodules were in the caudate lobe (2.8%). HCC was most common in segment 8 (n = 88, 27.4%) and least common in segment 1 (n = 9, 2.8%). No significant differences were found in the frequencies of segmental or lobar involvement considering patient demographic and clinical characteristics, nodule dimension, or disease appearance. Conclusions: The intrahepatic distribution of HCC differs among Couinaud’s segments, with segment 8 being the most common location and segment 1 being the least common. The segmental distribution of tumour location was similar to the normal liver volume distribution, supporting a possible correlation between HCC location and the volume of hepatic segments and/or the volumetric distribution of the portal blood flow.

2022 - Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients [Articolo su rivista]
Dajti, E; Renzulli, M; Colecchia, A; Bacchi-Reggiani, Ml; Milandri, M; Rossini, B; Ravaioli, F; Marasco, G; Alemanni, Lv; Ierardi, Am; Carrafiello, G; Pinzani, M; Azzaroli, F; Mazzella, G; Golfieri, R; Festi, D.
abstract

2022 - Spleen Stiffness Measurements Predict the Risk of Hepatic Decompensation after Direct-Acting Antivirals in HCV Cirrhotic Patients [Articolo su rivista]
Dajti, E.; Ravaioli, F.; Colecchia, A.; Marasco, G.; Bacchi Reggiani, M. L.; Colli, A.; Alemanni, L. V.; Tame, M.; Andreone, P.; Brillanti, S.; Azzaroli, F.; Mazzella, G.; Festi, D.
abstract

Purpose -Little evidence is available regarding the risk of hepatic decompensation (HD) after direct-acting antivirals (DAAs) in patients with advanced chronic liver disease. Our aim was to assess the risk of decompensation and the prognostic role of noninvasive tests, such as liver (LSM) and spleen (SSM) stiffness measurements, in the prediction of decompensation after sustained virologic response (SVR) by DAAs. Materials and Methods -A cohort study involving 146 cirrhotic patients treated with DAAs in our tertiary center with LSM and SSM available both before and six months after treatment (SVR24). A historical cohort of 92 consecutive cirrhotic patients with active HCV was used as a control group.-A propensity score inverse probability weighting method was used to account for differences between the groups. Time-dependent models for the prediction of decompensation were applied to account for changes in noninvasive tests after therapy. Results -The decompensation incidence in the DAA cohort was 7.07 (4.56-10.96) per 100 person-years (PYs), which was significantly lower than in the active HCV cohort. The DAA therapy was an independent protective factor for HD development (SHR: 0.071, 95-%-CI: 0.015-0.332). SSM ≥-54 kPa was independently associated with decompensation despite SVR achievement (SHR: 4.169, 95-%-CI: 1.050-16.559), alongside with a history of decompensation (SHR: 7.956, 95-%-CI: 2.556-24.762). SSM reduction <-10-% also predicted the risk of decompensation after SVR24. Conclusion -The risk of decompensation was markedly reduced after DAA therapy, but it was not eliminated. Paired SSM values stratified the risk of decompensation after SVR better than other noninvasive tests.

2022 - The interplay between sarcopenia and portal hypertension predicts ascites and mortality in cirrhosis [Articolo su rivista]
Dajti, E.; Renzulli, M.; Ravaioli, F.; Marasco, G.; Vara, G.; Brandi, N.; Rossini, B.; Colecchia, L.; Alemanni, L. V.; Ferrarese, A.; Vestito, A.; Tame, M.; Azzaroli, F.; Festi, D.; Golfieri, R.; Colecchia, A.
abstract

Background: The role of sarcopenia in predicting decompensation other than hepatic encephalopathy is unclear. We aimed to evaluate the prognostic role of sarcopenia, assessed by computed tomography (CT), in the development of ascites and mortality in patients with advanced chronic liver disease (ACLD) outside the liver transplantation (LT) setting. Material and Methods: We retrospectively evaluated ACLD patients with liver stiffness measurement (LSM) >10 kPa and an available CT scan within 6 months. Sarcopenia was defined as skeletal muscle index (SMI) <50 and <39 cm2/m2, respectively, in men and women. Competing risk regression models were used to assess the variables associated with the main outcomes. Results: 209 patients were included in the final analysis and sarcopenia was present in 134 (64.1%). During a median follow-up of 37 (20–63) months, 52 patients developed ascites, 24 underwent LT, and 30 died. Sarcopenia was found a predictive factor of decompensation with ascites (SHR 2.083, 95%-CI: 1.091–3.978), independently from the features of clinically significant portal hypertension (LSM≥21 kPa or portosystemic shunts). Sarcopenia (SHR: 2.744, 95%-CI: 1.105–6.816) and LSM≥21 kPa (SHR: 3.973, 95%-CI: 1.548–10.197) were independent risk factors for increased mortality. Conclusions: Sarcopenia and portal hypertension are two major and independent risk factors for decompensation with ascites and mortality in cirrhotic patients outside the LT context.

2022 - Validation of a standardized CT protocol for the evaluation of varices and porto-systemic shunts in cirrhotic patients [Articolo su rivista]
Renzulli, M.; Dajti, E.; Ierardi, A. M.; Brandi, N.; Berzigotti, A.; Milandri, M.; Rossini, B.; Clemente, A.; Ravaioli, F.; Marasco, G.; Azzaroli, F.; Carrafiello, G.; Festi, D.; Colecchia, A.; Golfieri, R.
abstract

Purpose: The aim of the present study was to propose and validate a standardized CT protocol for evaluating all the types of portosystemic collaterals (P-SC), including gastroesophageal varices and spontaneous portosystemic shunts (SPSS), and to evaluate the prognostic role of portal hypertension CT features for the prediction of the hepatic decompensation risk in cirrhotic patients. Methods: A retrospective cohort study of 184 advanced chronic liver disease who underwent CT scan between January 2014 and December 2017. Patients with an interval > 6 months between the imaging, elastometric, endoscopic and biochemical evaluation were excluded, as well as patients with previous transjugular intrahepatic portosystemic shunt (TIPS), liver transplantation (LT) or terminal medical conditions. Data on liver disease history, co-morbidities, endoscopic and radiologic findings were collected. The incidence of hepatic decompensation and other events, such as portal vein thrombosis, HCC, TIPS placement, LT, death, and its cause, were also recorded. The procedure was performed at baseline and after the administration of contrast agent using a multiphasic technique and bolus tracking. Two senior radiologists working in different centres and a non-expert radiologist reviewed all CT examinations, to evaluate both intra-observer and inter-observer variability of the CT protocol and to obtain an external validation. The radiological variables were evaluated using both univariate and adjusted multivariate competing risk regression models. Results: Both intra-observer and inter-observer agreement were excellent in detection and measurement of almost all types of P-SC. The presence of SPSS, a spleen diameter > 16 cm, a portal vein diameter > 17 mm and the presence of ascites resulted independent predictors of decompensation-free survival for cirrhotic patients and were incorporated in an easy-to-use score (AUROC = 0.799, p-value = 0.732) which can the risk of decompensation at 5 years, ranking it as low (11.3%), moderate (35.6%) or high (70.8%). Conclusions: The CT protocol commonly performed during the HCC surveillance program for cirrhotic patients is valid for detecting all types of P-SC. The radiological score identified to predict the decompensation-free survival for cirrhotic patients could be an easy-to-use clinical tool.

2021 - A Nomogram-Based Prognostic Model for Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib: A Multicenter Study [Articolo su rivista]
Marasco, G; Poggioli, F; Colecchia, A; Cabibbo, G; Pelizzaro, F; Giannini, Eg; Marinelli, S; Rapaccini, Gl; Caturelli, E; Di Marco, M; Biasini, E; Marra, F; Morisco, F; Foschi, Fg; Zoli, M; Gasbarrini, A; Svegliati Baroni, G; Masotto, A; Sacco, R; Raimondo, G; Azzaroli, F; Mega, A; Vidili, G; Brunetto, Mr; Nardone, G; Alemanni, Lv; Dajti, E; Ravaioli, F; Festi, D; Trevisani, F; Italian Liver Cancer Ita Li Ca Group, Obot
abstract

2021 - Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice [Articolo su rivista]
Ferrarese, A.; Passigato, N.; Cusumano, C.; Gemini, S.; Tonon, A.; Dajti, E.; Marasco, G.; Ravaioli, F.; Colecchia, A.
abstract

Patients with cirrhosis show an increased susceptibility to infection due to disease-related immune-dysfunction. Bacterial infection therefore represents a common, often detrimental event in patients with advanced liver disease, since it can worsen portal hypertension and impair the function of hepatic and extrahepatic organs. Among pharmacological strategies to prevent infection, antibiotic prophylaxis remains the first-choice, especially in high-risk groups, such as patients with acute variceal bleeding, low ascitic fluid proteins, and prior episodes of spontaneous bacterial peritonitis. Nevertheless, antibiotic prophylaxis has to deal with the changing bacterial epidemiology in cirrhosis, with increased rates of gram-positive bacteria and multidrug resistant rods, warnings about quinolones-related side effects, and low prescription adherence. Short-term antibiotic prophylaxis is applied in many other settings during hospitalization, such as before interventional or surgical procedures, but often without knowledge of local bacterial epidemiology and without strict adherence to antimicrobial stewardship. This paper offers a detailed overview on the application of antibiotic prophylaxis in cirrhosis, according to the current evidence.

2021 - Clinical impact of sarcopenia assessment in patients with liver cirrhosis [Articolo su rivista]
Marasco, G; Dajti, E; Ravaioli, F; Brocchi, S; Rossini, B; Alemanni, Lv; Peta, G; Bartalena, L; Golfieri, R; Festi, D; Colecchia, A; Renzulli, M.
abstract

2021 - Clinical presentation of celiac disease and diagnosis accuracy in a single-center european pediatric cohort over 10 years [Articolo su rivista]
Di Biase, A. R.; Marasco, G.; Ravaioli, F.; Colecchia, L.; Dajti, E.; Lecis, M.; Passini, E.; Alemanni, L. V.; Festi, D.; Iughetti, L.; Colecchia, A.
abstract

(1) Background: Changes in the clinical presentation of celiac disease (CD) in children have been reported. The guidelines of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) allow esophagogastroduodenoscopy (EGD) with biopsies to be avoided under specific circumstances. We aimed to assess the clinical picture of pediatric CD patients at diagnosis and to validate ESPGHAN non-biopsy criteria. (2) Methods: Patients with suspected CD or undergoing screening from 2004 to 2014 at the University Hospital in Modena, Italy were enrolled. The accuracy of ESPGHAN non-biopsy criteria and modified versions were assessed. (3) Results: In total, 410 patients were enrolled, of whom 403 were considered for analysis. Of the patients considered, 45 were asymptomatic and diagnosed with CD (11.2%) while 358 patients (88.2%) were symptomatic, of whom 295 were diagnosed with CD. Among symptomatic CD patients, 57 (19.3%) had gastrointestinal symptoms, 98 (33%) had atypical symptoms and 140 (47.4%) had both. No difference was found for the presence of gastrointestinal symptoms at different ages. The non-biopsy ESPGHAN criteria yielded an accuracy of 59.4% with a positive predictive value (PPV) of 100%; 173 out of 308 EGD (56.2%) could have been avoided. The modified 7× and 5× upper limit of normal cut-offs for IgA anti tissue-transglutaminase reached 60.7% and 64.3% of EGD avoided, respectively. (4) Conclusions: Over 10 years, late age at diagnosis and increased rates of atypical CD presentation were found. ESPGHAN non-biopsy criteria are accurate for CD diagnosis and allow half of unneeded EGD to be avoided. Modified versions allowed sparing a greater number of EGD.

2021 - Comparison of prognostic models in advanced hepatocellular carcinoma patients undergoing Sorafenib: A multicenter study [Articolo su rivista]
Marasco, G; Colecchia, A; Bacchi Reggiani, Ml; Celsa, C; Farinati, F; Giannini, Eg; Benevento, F; Rapaccini, Gl; Caturelli, E; Di Marco, M; Biasini, E; Marra, F; Morisco, F; Foschi, Fg; Zoli, M; Gasbarrini, A; Baroni, Gs; Masotto, A; Sacco, R; Raimondo, G; Azzaroli, F; Mega, A; Vidili, G; Brunetto, Mr; Nardone, G; Dajti, E; Ravaioli, F; Avanzato, F; Festi, D; Trevisani, F; ) group, Italian Liver Cancer (ITA. LI. CA.
abstract

2021 - Elastography: where are we now? [Articolo su rivista]
Giuffrè, M; Colecchia, A; Crocè, Ls
abstract

2021 - Gut microbiota signatures and clinical manifestations in celiac disease children at onset: a pilot study [Articolo su rivista]
Di Biase, Anna Rita; Marasco, Giovanni; Ravaioli, Federico; Dajti, Elton; Colecchia, Luigi; Righi, Beatrice; D'Amico, Virginia; Festi, Davide; Iughetti, Lorenzo; Colecchia, Antonio
abstract

Recent researches have shown an altered gut microbiota in celiac disease (CD) patients compared with healthy controls (HCs). This study aims to evaluate the composition of the microbiota of CD children at onset and the relationship between bacterial abundances and symptoms.

2021 - Imaging Software-Based Sarcopenia Assessment in Gastroenterology: Evolution and Clinical Meaning [Articolo su rivista]
Marasco, G; Sadalla, S; Vara, G; Golfieri, R; Festi, D; Colecchia, A; Renzulli, M.
abstract

2021 - Liver and Spleen Stiffness in Vascular Liver Disease [Capitolo/Saggio]
Ravaioli, F.; Dajti, E.; Alemanni, L. V.; Colecchia, A.
abstract

Vascular liver disease related to portal hypertension is an exciting and not completely studied issue that includes the most common manifestations of non-cirrhotic portal hypertension, acute non-cirrhotic portal vein thrombosis (NCPVT), extrahepatic portal vein obstruction (EHPVO), and idiopathic non-cirrhotic portal hypertension (INCPH).

2021 - Microbial Signatures in Celiac Disease: Still Far From a Final Answer [Articolo su rivista]
Marasco, G; Di Biase, Ar; Colecchia, A
abstract

2021 - Pre-transplant psoas muscle density as a ready-to-use and low-cost predictor of patient survival after liver transplant [Articolo su rivista]
Bertuzzo, V. R.; Renzulli, M.; Clemente, A.; Cucchetti, A.; Maroni, L.; Frascaroli, G.; Pellegrini, S.; Dajti, E.; Spinelli, D.; Peta, G.; Ierardi, A. M.; Carrafiello, G.; Strigari, L.; Colecchia, A.; Golfieri, R.; Pinna, A. D.; Ravaioli, M.; Cescon, M.
abstract

Background: Sarcopenia, defined as low muscle mass with reduced function, is frequently encountered in cirrhotic patients and is a major predictor of adverse events, including post-liver transplant (LT) outcome. Objectives: This study assessed the impact of sarcopenia using computed tomography (CT-based measurements on post-LT mortality and complications. Methods: From January 2008 to June 2016, 646 adult patients underwent 613 LTs at our institution. We analyzed the postoperative outcome of 287 patients who had pathologically proven cirrhosis on the explanted liver and who had performed a CT examination three months before LT. Psoas muscle density (PMD) was detected for every patient using standard instruments present in the radiological workstation and was related to postoperative survival rates and complications. Statistical analysis was carried out using the appropriate tests. Results: Postoperative mortality was 6.3%. At least one grade III-IV postoperative complication was experienced by 121 patients. Respiratory and infective complications occurred in 30 and 32 patients, respectively. Also, PMD was an independent predictor of postoperative mortality (P = 0.021), respiratory complications (P = 0.015), and infections (P = 0.010). The ROC analysis identified a PMD 43.72 HU as the best cutoff value for predicting 90-day mortality after LT. Conclusions: Psoas muscle density accurately predicted post-LT mortality and complications. Its ease and low-cost determination can allow widespread use of this parameter to improve clinical care and help with the decision to give these patients some priority on the transplant waiting list.

2021 - Prognostic Value of the Albumin-Bilirubin Grade for the Prediction of Post-Hepatectomy Liver Failure: A Systematic Review and Meta-Analysis. [Articolo su rivista]
Marasco, G; Alemanni, Lv; Colecchia, A; Festi, D; Bazzoli, F; Mazzella, G; Montagnani, M; Azzaroli, F
abstract

2021 - Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness. [Articolo su rivista]
Dajti, E; Marasco, G; Ravaioli, F; Colecchia, L; Ferrarese, A; Festi, D; Colecchia, A
abstract

2021 - The role of liver and spleen elastography in advanced chronic liver disease [Articolo su rivista]
Dajti, E; Marasco, G; Ravaioli, F; Alemanni, Lv; Rossini, B; Colecchia, L; Vestito, A; Festi, D; Colecchia, A
abstract

2020 - A novel spleen-dedicated stiffness measurement by FibroScan® improves the screening of high-risk oesophageal varices [Articolo su rivista]
Stefanescu, H.; Marasco, G.; Cales, P.; Fraquelli, M.; Rosselli, M.; Ganne-Carrie, N.; de Ledinghen, V.; Ravaioli, F.; Colecchia, A.; Rusu, C.; Andreone, P.; Mazzella, G.; Festi, D.
abstract

Background & Aims Several non-invasive tests (NITs) have been developed to diagnose oesophageal varices (EV), including the recent Baveno VI criteria to rule out high-risk varices (HRV). Spleen stiffness measurement (SSM) with the standard FibroScan (R) (SSM@50Hz) has been evaluated. However, the EV grading could be underestimated because of a ceiling threshold (75 kPa) of the SSM@50Hz. The aims were to evaluate SSM by a novel spleen-dedicated FibroScan (R) (SSM@100Hz) for EV diagnosis compared with SSM@50Hz, other validated NITs and Baveno VI criteria. Methods This prospective multicentre study consecutively enrolled patients with chronic liver disease; blood data, endoscopy, liver stiffness measurement (LSM), SSM@50Hz and SSM@100Hz were collected. Results Two hundred and sixty patients met inclusion criteria. SSM@100Hz success rate was significantly higher than that of SSM@50Hz (92.5% vs 76.0%, P < .001). SSM@100Hz accuracy for the presence of EV (AUC = 0.728) and HRV (AUC = 0.756) was higher than in other NITs. SSM@100Hz AUC for large EV (0.782) was higher than SSM@50Hz (0.720, P = .027). AUC for HRV with SSM@100Hz (0.780) was higher than with LSM (0.615, P < .001). The spared endoscopy rate of Baveno VI criteria (8.1%) was significantly increased by the combination to SSM@50Hz (26.5%) or SSM@100Hz (38.9%, P < .001 vs others). The missed HRV rate was, respectively, 0% and 4.7% for combinations. Conclusions SSM@100Hz is a new performant non-invasive marker for EV and HRV providing a higher accuracy than SSM@50Hz and other NITs. The combination of Baveno VI criteria and SSM@100Hz significantly increased the spared endoscopy rate compared to Baveno VI criteria alone or combined with SSM@50Hz. Clinical trial number: NCT02180113.

2020 - Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments [Articolo su rivista]
Marasco, G; Serenari, M; Renzulli, M; Alemanni, Lv; Rossini, B; Pettinari, I; Dajti, E; Ravaioli, F; Golfieri, R; Cescon, M; Festi, D; Colecchia, A
abstract

2020 - Clinical outcomes after treatment with direct-acting antivirals: not all concern hepatocellular carcinoma risk. [Articolo su rivista]
Dajti, E; Ravaioli, F; Festi, D; Colecchia, A
abstract

2020 - Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation [Articolo su rivista]
Bonifazi, F; Barbato, F; Ravaioli, F; Sessa, M; Defrancesco, I; Arpinati, M; Cavo, M; Colecchia, A
abstract

Hepatic veno-occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS) is a rare complication characterized by hepatomegaly, right-upper quadrant pain, jaundice, and ascites, occurring after high-dose chemotherapy, hematopoietic stem cell transplantation (HSCT) and, less commonly, other conditions. We review pathogenesis, clinical appearance and diagnostic criteria, risk factors, prophylaxis, and treatment of the VOD occurring post-HSCT. The injury of the sinusoidal endothelial cells with loss of wall integrity and sinusoidal obstruction is the basis of development of postsinusoidal portal hypertension responsible for clinical syndrome. Risk factors associated with the onset of VOD and diagnostic tools have been recently updated both in the pediatric and adult settings and here are reported. Treatment includes supportive care, intensive management, and specific drug therapy with defibrotide. Because of its severity, particularly in VOD with associated multiorgan disease, prophylaxis approaches are under investigation. During the last years, decreased mortality associated to VOD/SOS has been reported being it attributable to a better intensive and multidisciplinary approach.

2020 - Imaging in Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome [Articolo su rivista]
Chan, Ss; Colecchia, A; Duarte, Rf; Bonifazi, F; Ravaioli, F; Bourhis, Jh
abstract

2020 - Is Ultrasound Elastography Useful in Predicting Clinically Relevant Pancreatic Fistula After Pancreatic Resection?: A Systematic Review and Meta-analysis [Articolo su rivista]
Marasco, G; Ricci, C; Buttitta, F; Dajti, E; Ravaioli, F; Ingaldi, C; Alberici, L; Serra, C; Festi, D; Colecchia, A; Casadei, R
abstract

2020 - Liver fibrosis by FibroScan(®) independently of established cardiovascular risk parameters associates with macrovascular and microvascular complications in patients with type 2 diabetes [Articolo su rivista]
Lombardi, R; Airaghi, L; Targher, G; Serviddio, G; Maffi, G; Mantovani, A; Maffeis C, ; Colecchia, A; Villani, R; Rinaldi, L; Orsi, E; Pisano, G; Adinolfi, Le; Fargion, S; Fracanzani, Al
abstract

2020 - NAFLD fibrosis score (NFS) can be used in outpatient services to identify chronic vascular complications besides advanced liver fibrosis in type 2 diabetes [Articolo su rivista]
Rosa, Lombardi; Lorena, Airaghi; Giovanni, Targher; Gaetano, Serviddio; Gabriele, Maffi; Alessandro, Mantovani; Claudio, Maffeis; Colecchia, A; Rosanna, Villani; Luca, Rinaldi; Emanuela, Orsi; Giuseppina, Pisano; Luigi Elio, Adinolfi; Silvia, Fargion; Anna Ludovica, Fracanzani
abstract

2020 - Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly [Articolo su rivista]
Marasco, G.; Colecchia, A.; Milandri, M.; Rossini, B.; Alemanni, L. V.; Dajti, E.; Ravaioli, F.; Renzulli, M.; Golfieri, R.; Festi, D.
abstract

Post-hepatectomy liver failure (PHLF) is associated with great morbidity and mortality after resection of hepatocellular carcinoma. Previous studies have underlined that advanced age could be a potential factor influencing post-operative complications and long-term survival. In the past, candidates for resection were based on the Child-Pugh classification, the predictive value of which was rather low. The selection of patients undergoing resection in Western countries is based on the assessment of portal hypertension (PH), which is clinically assessed by measurement of the hepatic venous pressure gradient, an invasive and costly process. Thus, there have been several attempts to identify the best non-invasive test (NIT) to accurately predict PHLF. Most biochemical NITs for the prediction of PHLF are focused on evaluation of underlying liver cirrhosis and PH. Amongst them, FIB-4, which also includes the patient’s age, seems to have more robust supporting results. In Europe and the USA., the most tested and reliable NIT for predicting PHLF is the evaluation of liver stiffness measurement, which is also influenced by age. Imaging parameters are promising tools which are used only in specialized centers however, and when available. Liver volume parameters, as well as contrast-enhanced data, demonstrate good accuracy in predicting PHLF. In this scenario, the evaluation of sarcopenia and bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly patients. Further studies focused on parameters for the evaluation of PHLF in elderly patients are needed.

2020 - Non-invasive tests for the prediction of primary hepatocellular carcinoma [Articolo su rivista]
Marasco, G; Colecchia, A; Silva, G; Rossini, B; Eusebi, Lh; Ravaioli, F; Dajti, E; Alemanni, Lv; Colecchia, L; Renzulli, M; Golfieri, R; Festi, D
abstract

2020 - PNPLA3 I148M gene variant and chronic kidney disease in type 2 diabetic patients with NAFLD: Clinical and experimental findings [Articolo su rivista]
Mantovani, A; Taliento, A; Zusi, C; Baselli, G; Prati, D; Granata, S; Zaza, G; Colecchia, A; Maffeis, C; Byrne, Cd; Valenti, L; Targher, G
abstract

2020 - Pancreatic ultrasound elastography is not useful to predict the risk of pancreatic fistulas after pancreatic resection [Articolo su rivista]
Marasco, G; Ricci, C; Grasso, V; Alvisi, M; Serra, C; Ravaioli, F; Casadei, R; Colecchia, A
abstract

2020 - Predictive factors for hepatocellular carcinoma recurrence after curative treatments [Articolo su rivista]
Marasco, G.; Ravaioli, F.; Vestito, A.; Rossini, B.; Dajti, E.; Colecchia, L.; Gjini, K.; Renzulli, M.; Golfieri, R.; Festi, D.; Colecchia, A.
abstract

Hepatocellular carcinoma (HCC) is the fifth most common neoplasm worldwide. Recurrence of HCC after resection or loco-regional therapies represents an important clinical issue as it affects up to 70% of patients. This can be divided into early or late, if it occurs within or after 24 months after treatment, respectively. While the predictive factors for early recurrence are mainly related to tumour biology (local invasion and intrahepatic metastases), late recurrences are mainly related to de novo tumour formation. Thus, it is important to recognize these factors prior to any treatment in each patient, in order to optimize the treatment strategy and follow-up after treatment. The aim of this review is to summarize the current evidence available regarding predictive factors for the recurrence of HCC, according to the different therapeutic strategies available. In particular, we will discuss the role of new ultrasound-based techniques and biological features, such as tumor-related and circulating biomarkers, in predicting HCC recurrence. Recent advances in imaging-related parameters in computed-tomography scans and magnetic resonance imaging will also be discussed.

2020 - Probiotics, Prebiotics and Other Dietary Supplements for Gut Microbiota Modulation in Celiac Disease Patients [Articolo su rivista]
Marasco, G; Cirota, Gg; Rossini, B; Lungaro, L; Di Biase, Ar; Colecchia, A; Volta, U; De Giorgio, R; Festi, D; Caio, G.
abstract

2020 - Screening for non-alcoholic fatty liver disease using liver stiffness measurement and its association with chronic kidney disease and cardiovascular complications in patients with type 2 diabetes [Articolo su rivista]
Mantovani, A; Turino, T; Lando, Mg; Gjini, K; Byrne, Cd; Zusi, C; Ravaioli, F; Colecchia, A; Maffeis, C; Salvagno, G; Lippi, G; Bonora, E; Targher, G
abstract

2020 - Spleen stiffness measurement for assessing the response to β-blockers therapy for high-risk esophageal varices patients [Articolo su rivista]
Marasco, G; Dajti, E; Ravaioli, F; Alemanni, Lv; Capuano, F; Gjini, K; Colecchia, L; Puppini, G; Cusumano, C; Renzulli, M; Golfieri, R; Festi, D; Colecchia, A
abstract

2019 - "Are the Expanded Baveno VI Criteria really safe to screen compensated cirrhotic patients for high-risk varices?" [Articolo su rivista]
Dajti, E; Ravaioli, F; Colecchia, A; Marasco, G; Calès, P; Festi, D
abstract

2019 - Association between PNPLA3rs738409 polymorphism decreased kidney function in postmenopausal type 2 diabetic women with or without non-alcoholic fatty liver disease [Articolo su rivista]
Mantovani, A; Zusi, C; Sani, E; Colecchia, A; Lippi, G; Zaza, Gl; Valenti, L; Byrne CD, ; Maffeis, C; Bonora, E; Targher, G
abstract

2019 - Association between non-alcoholic fatty liver disease and bone turnover biomarkers in post-menopausal women with type 2 diabetes [Articolo su rivista]
Mantovani, A; Sani, E; Fassio, A; Colecchia, A; Viapiana, O; Gatti, D; Idolazzi, L; Rossini, M; Salvagno, G; Lippi, G; Zoppini, G; Byrne, Cd; Bonora, E; Targher, G.
abstract

2019 - HEPATIC DECOMPENSATION RISK IS REDUCED, BUT NOT ELIMINATED AFTER DIRECT-ACTING ANTIVIRALS: THE ROLE OF SPLEEN STIFFNESS MEASUREMENT [Relazione in Atti di Convegno]
Marasco, G; Dajti, E; Ravaioli, F; Colecchia, A; Reggiani, Mlb; Colli, A; Alemanni, Lv; Tame, Mr; Andreone, P; Brillanti, S; Azzaroli, F; Mazzella, G; Festi, D
abstract

2019 - Liver Stiffness Measurement Allows Early Diagnosis of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome in Adult Patients Who Undergo Hematopoietic Stem Cell Transplantation: Results from a Monocentric Prospective Study [Articolo su rivista]
Colecchia, A; Ravaioli, F; Sessa, M; Alemanni, Vl; Dajti, E; Marasco, G; Vestito, A; Zagari, Rm; Barbato, F; Arpinati, M; Cavo, M; Festi, D; Bonifazi, F
abstract

2019 - Liver and Spleen Stiffness Measurements for Assessment of Portal Hypertension Severity in Patients with Budd Chiari Syndrome [Articolo su rivista]
Dajti, E; Ravaioli, F; Colecchia, A; Marasco, G; Vestito, A; Festi, D
abstract

2019 - Prediction of posthepatectomy liver failure: Role of SSM and LSPS [Articolo su rivista]
Marasco, G; Colecchia, A; Dajti, E; Ravaioli, F; Cucchetti, A; Cescon, M; Festi, D.
abstract

2019 - Reply to correspondence concerning: "Role of liver and spleen stiffness in predicting the recurrence of hepatocellular carcinoma after resection" [Articolo su rivista]
Marasco, G; Colecchia, A; Colli, A; Ravaioli, F; Casazza, G; Bacchi Reggiani, Ml; Cucchetti, A; Cescon, M; Festi, D
abstract

2019 - Role of imaging techniques in liver veno-occlusive disease diagnosis: recent advances and literature review [Articolo su rivista]
Ravaioli, F; Colecchia, A; Alemanni, Lv; Vestito, A; Dajti, E; Marasco, G; Sessa, M; Pession, A; Bonifazi, F; Festi, D
abstract

2019 - Role of liver and spleen stiffness in predicting the recurrence of hepatocellular carcinoma after resection [Articolo su rivista]
Marasco, G; Colecchia, A; Colli, A; Ravaioli, F; Casazza, G; Bacchi Reggiani, Ml; Cucchetti, A; Cescon, M; Festi, D
abstract

2019 - Sound Conclusions: How Splenic Elastography May Decrease the Need for Endoscopic Variceal Surveillance [Articolo su rivista]
Ravaioli, F; Colecchia, A
abstract

2019 - The concept of therapeutic hierarchy for patients with hepatocellular carcinoma: A multicenter cohort study [Articolo su rivista]
Vitale, A; Farinati, F; Pawlik, Tm; Frigo, Ac; Giannini, Eg; Napoli, L; Ciccarese, F; Rapaccini, Gl; Di Marco, M; Caturelli, E; Zoli, M; Borzio, F; Sacco, R; Cabibbo, G; Virdone, R; Marra, F; Felder, M; Morisco, F; Benvegnù, L; Gasbarrini, A; Svegliati-Baroni, G; Foschi, Fg; Missale, G; Masotto, A; Nardone, G; Colecchia, A; Bernardi, M; Trevisani, F; Cillo, U
abstract

2018 - A SPLEEN STIFFNESS MEASUREMENT-BASED MODEL FOR THE RECOGNITION OF HIGH RISK VARICES: BAVENO VI CRITERIA AND BEYOND [Abstract in Rivista]
Ravaioli, F.; Colecchia, A.; Marasco, G.; Colli, A.; Dajti, E.; Alemanni, V. L.; Di Biase, A.; Reggiani, M. L. Bacchi; Berzigotti, A.; Pinzani, M.; Festi, D.
abstract

2018 - A combined model based on spleen stiffness measurement and Baveno VI criteria to rule out high-risk varices in advanced chronic liver disease [Articolo su rivista]
Colecchia, A; Ravaioli, F; Marasco, G; Colli, A; Dajti, E; Di Biase, Ar; Bacchi Reggiani, Ml; Berzigotti, A; Pinzani, M; Festi, D
abstract

2018 - A spleen stiffness measurement-based model for recognition of high risk varices: Baveno VI criteria and beyond [Abstract in Rivista]
Ravaioli, F.; Colecchia, A.; Marasco, G.; Colli, A.; Dajti, Elton; DI Biase, A.; Reggiani, M. L. B.; Berzigotti, A.; Pinzani, M.; Festi, D.
abstract

2018 - A spleen stiffness measurement-based model for the recognition of high risk varices: Baveno VI criteria and beyond [Abstract in Rivista]
Colecchia, A.; Ravaioli, F.; Marasco, G.; Colli, Andrea; Dajti, E.; Di Biase, A.; Bacchi Reggiani, M. L.; Berzigotti, A.; Pinzani, M.; Festi, D.
abstract

2018 - Corrigendum to “Differences in liver stiffness values obtained with new ultrasound elastography machines and fibroscan: A comparative study” [Dig. Liver Dis. 49 (2017) 802–808](S1590865817302463)(10.1016/j.dld.2017.03.001) [Articolo su rivista]
Piscaglia, F; Salvatore, V; Mulazzani, L; Cantisani, V; Colecchia, A; Di Donato, R; Felicani, C; Ferrarini, A; Gamal, N; Grassoc, V; Marasco, G; Mazzotta, E; Ravaioli, F; Ruggieri, G; Serio, I; Sitouok Nkamgho, Jf; Serra, C; Festi, D; Schiavone, C; Bolondi L,
abstract

2018 - Hepatocellular carcinoma risk assessment by the measurement of liver stiffness variations in HCV cirrhotics treated with direct acting antivirals [Articolo su rivista]
Ravaioli, Federico; Conti, Fabio; Brillanti, Stefano; Andreone, Pietro; Mazzella, Giuseppe; Buonfiglioli, Federica; Serio, Ilaria; Verucchi, Gabriella; Bacchi Reggiani, Maria Letizia; Colli, Agostino; Marasco, Giovanni; Colecchia, Antonio; Festi, Davide
abstract

Background: Direct-acting antivirals (DAA) are an effective treatment for hepatitis C virus infection. However, sustained virologic response (SVR) after DAA treatment does not seem to reduce the risk of hepatocellular carcinoma (HCC) development in these patients. Liver stiffness measurement (LSM) may predict the risk of developing HCC in liver cirrhosis patients. Aims: The aim of our study was to evaluate the role of LSM variation as predictor of HCC development in patients treated with DAA. Methods: In 139 HCV-related cirrhotic patients, LSM and laboratory tests were carried out at baseline (BL) and at the end of DAA treatment (EOT). Patients were followed for at least 6 months after the EOT. LSM reduction was expressed as Delta LS (∆LS). Cox regression analysis was used to identify prognostic factors for HCC development after DAA. Results: Median LSM values were significantly reduced from BL to EOT (from 18.6 to 13.8 kPa; p < 0.001). The median ∆LS was −26.7% (IQR: −38.4% −13.6%). During a median follow-up of 15 months after DAA treatment, 20 (14.4%) patients developed HCC. Significant LSM reduction was observed both in patients who developed HCC and in those who did not, but this was significantly lower in the patients who developed HCC (−18.0% vs −28.9% p = 0.005). At multivariate analysis, ∆LS lower than −30%, Child-Turcotte-Pugh-B and history of HCC were independently associated with HCC development. Conclusion: Our results indicate that ∆LS is a useful non-invasive marker for predicting HCC development after DAA treatment.

2018 - Pancreatic ultrasound elastography and its clinical use in predicting the risk of pancreatic fistulas after pancreatic resection [Abstract in Rivista]
Pacilio, Carlo Alberto; Marasco, Giovanni; Ricci, Claudio; Colecchia, Antonio; Alvisi, Margherita; Serra, Carla; Grasso, Valentina; Ravaioli, Federico; Minni, Francesco; Festi, Davide; Casadei, Riccardo
abstract

2018 - Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice [Articolo su rivista]
Giannini, Edoardo Giovanni; Bucci, Laura; Garuti, Francesca; Brunacci, Matteo; Lenzi, Barbara; Valente, Matteo; Caturelli, Eugenio; Cabibbo, Giuseppe; Piscaglia, Fabio; Virdone, Roberto; Felder, Martina; Ciccarese, Francesca; Foschi, Francesco Giuseppe; Sacco, Rodolfo; Svegliati Baroni, Gianluca; Farinati, Fabio; Rapaccini, Gian Lodovico; Olivani, Andrea; Gasbarrini, Antonio; Di Marco, Maria; Morisco, Filomena; Zoli, Marco; Masotto, Alberto; Borzio, Franco; Benvegnù, Luisa; Marra, Fabio; Colecchia, Antonio; Nardone, Gerardo; Bernardi, Mauro; Trevisani, Franco
abstract

The Barcelona Clinic Liver Cancer (BCLC) advanced stage (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population, where sorafenib alone is the recommended treatment. In this study, our aim was to assess treatment and overall survival (OS) of BCLC C patients subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified as: PS1 alone (n = 385; 46.1%), PS2 alone (n = 146; 17.5%), MVI (n = 224; 26.8%), EHS (n = 51; 6.1%), and MVI + EHS (n = 29; 3.5%). MVI, EHS, and MVI + EHS patients had larger and multifocal/massive HCCs and higher alpha-fetoprotein (AFP) levels than PS1 and PS2 patients. Median OS significantly declined from PS1 (38.6 months) to PS2 (22.3 months), EHS (11.2 months), MVI (8.2 months), and MVI + EHS (3.1 months; P < 0.001). Among MVI patients, OS was longer in those with peripheral than with central (portal trunk) MVI (11.2 vs. 7.1 months; P = 0.005). The most frequent treatments were: curative approaches in PS1 (39.7%), supportive therapy in PS2 (41.8%), sorafenib in MVI (39.3%) and EHS (37.3%), and best supportive care in MVI + EHS patients (51.7%). Independent prognostic factors were: Model for End-stage Liver Disease score, Child-Pugh class, ascites, platelet count, albumin, tumor size, MVI, EHS, AFP levels, and treatment type. CONCLUSION: BCLC C stage does not identify patients homogeneous enough to be allocated to a single stage. PS1 alone is not sufficient to include a patient into this stage. The remaining patients should be subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed.

2018 - Persistent Fever and Abdominal Pain in a Young Woman With Budd-Chiari Syndrome [Articolo su rivista]
Liverani, Elisa; Colecchia, Antonio; Mazzella, Giuseppe
abstract

Question: A 23-year-old woman with Budd-Chiari syndrome in treatment with warfarin was admitted to our unit because of the persistence of fever, severe abdominal pain, diarrhea, and marked weight loss. Her medical history included recurrent oral and genital aphthous ulcers, arthritis, and erythema nodosum. Two months before admission, she underwent urgent left hemicolectomy for a massive intestinal hemorrhage. Treatment with corticosteroids was started after diagnosing probable Behçet’s disease (BD). At admission, the patient presented with tachycardia and hypotension; her abdomen was mildly distended, with a generalized tenderness to palpation without rebound or guarding. The methylprednisolone dose had recently been tapered to 4 mg/d because of hirsutism. Laboratory tests revealed neutrophilic leukocytosis, mild thrombocytosis, severe microcytic anemia, mild elevation of the International Normalized Ratio, alkaline phosphatase, and gamma-glutamyl transferase, and a marked increase of C-reactive protein and the erythrocyte sedimentation rate. A contrast-enhanced abdominal computed tomography scan demonstrated spread areas of low-attenuation with “rim enhancement” in the liver and spleen, compatible with multiple abscesses (Figure A, B), necrotic celiac and paraaortic lymph nodes (Figure C), almost complete thrombosis of the right and left hepatic veins, and thrombosis of the distal tract of the splenic vein. Steroid therapy was discontinued immediately. Despite the negativity of blood, urine, and stool cultures, an empirical antibiotic therapy with piperacillin/tazobactam and teicoplanin was started. Nevertheless, there was a sudden worsening of the hemodynamic state, unresponsive to a fill fluid challenge, and therefore, it was necessary to transfer the patient to the intensive care unit

2018 - Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study [Articolo su rivista]
Vitale, A; Farinati, F; Noaro, G; Burra, P; Pawlik, Tm; Bucci, L; Giannini, Eg; Faggiano, C; Ciccarese, F; Rapaccini, Gl; Di Marco, M; Caturelli, E; Zoli, M; Borzio, F; Sacco, R; Cabibbo, G; Virdone, R; Marra, F; Felder, M; Morisco, F; Benvegnù, L; Gasbarrini, A; Svegliati-Baroni, G; Foschi, Fg; Olivani, A; Masotto, A; Nardone, G; Colecchia, A; Fornari, F; Marignani, M; Vicari, S; Bortolini, E; Cozzolongo, R; Grasso, A; Aliberti, C; Bernardi, M; Frigo, Ac; Borzio, M; Trevisani, F; Cillo, U; CA) group, Italian Liver Cancer (ITA. LI.
abstract

2018 - Role and clinical meaning of non-invasive tests in the evaluation of portal hypertension in patients with advanced chronic liver disease [Articolo su rivista]
Festi, D; Dajti, E; Ravaioli, F; Marasco, G; Colecchia, A
abstract

2018 - Spleen Stiffness by Ultrasound Elastography [Capitolo/Saggio]
Colecchia, A; Ravaioli, F; Marasco, G; and Festi, D
abstract

2018 - Spleen stiffness decrease as mirror of portal hypertension changes after successful interferon-free therapy in chronic-HCV patients [Abstract in Rivista]
Ravaioli, F.; Dajti, E.; Colecchia, A.; Alemanni, LUIGINA VANESSA; Marasco, G.; Tamé, M.; Azzaroli, F.; Brillanti, S.; Mazzella, G.; Festi, D.
abstract

2018 - Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients [Articolo su rivista]
Ravaioli, F; Colecchia, A; Dajti, E; Marasco, G; Alemanni, Lv; Tamè, M; Azzaroli, F; Brillanti, S; Mazzella, G; Festi, D
abstract

2018 - Utility of Tumor Burden Score to Stratify Prognosis of Patients with Hepatocellular Cancer: Results of 4759 Cases from ITA.LI.CA Study Group [Articolo su rivista]
Vitale, A; Lai, Q; Farinati, F; Bucci, L; Giannini, Eg; Napoli, L; Ciccarese, F; Rapaccini, Gl; Di Marco, M; Caturelli, E; Zoli, M; Borzio, F; Sacco, R; Cabibbo, G; Virdone, R; Marra, F; Felder, M; Morisco, F; Benvegnù, L; Gasbarrini, A; Svegliati-Baroni, G; Foschi, Fg; Missale, G; Masotto, A; Nardone, G; Colecchia, A; Bernardi, M; Trevisani, F; Pawlik, Tm; Italian Liver Cancer, (ITA. LI. CA) group.
abstract

2017 - A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma [Articolo su rivista]
Cabibbo, Giuseppe; Petta, Salvatore; BarbÃ ra, Marco; Missale, Gabriele; Virdone, Roberto; Caturelli, Eugenio; Piscaglia, Fabio; Morisco, Filomena; Colecchia, Antonio; Farinati, Fabio; Giannini, Edoardo; Trevisani, Franco; CraxÃ¬, Antonio; Colombo, Massimo; CammÃ , Calogero; Bucci, Laura; Zoli, Marco; Garuti, Francesca; Lenzi, Barbara; Biselli, Maurizio; Caraceni, Paolo; Cucchetti, Alessandro; Gramenzi, Annagiulia; Granito, Alessandro; Magalotti, Donatella; Serra, Carla; Negrini, Giulia; Napoli, Lucia; Salvatore, Veronica; Benevento, Francesca; BenvegnÃ¹, Luisa; Gazzola, Alessia; Murer, Francesca; Pozzan, Caterina; Vanin, Veronica; Moscatelli, Alessandro; Pellegatta, Gaia; Picciotto, Antonino; Savarino, Vincenzo; Ciccarese, Francesca; Del Poggio, Paolo; Olmi, Stefano; de Matthaeis, Nicoletta; Balsamo, Mariella Di Marco Claudia; Vavassori, Elena; Roselli, Paola; Dellâ€™Isola, Serena; Ialungo, Anna Maria; Rastrelli, Elena; Attardo, Simona; Rossi, Margherita; Costantino, Andrea; Affronti, Andrea; Affronti, Marco; Mascari, Marta; Felder, Martina; Mega, Andrea; Gasbarrini, Antonio; Pompili, Maurizio; Rinninella, Emanuele; Sacco, Rodolfo; Mismas, Valeria; Foschi, Francesco Giuseppe; Dallâ€™Aglio, Anna Chiara; Feletti, Valentina; Lanzi, Arianna; Cappa, Federica Mirici; Neri, Elga; Stefanini, Giuseppe Francesco; Tamberi, Stefano; Olivani, Andrea; Biasini, Elisabetta; Nardone, Gerardo; Guarino, Maria; Svegliati-Baroni, Gialuca; Ortolani, Alessio; Masotto, Alberto; Marchetti, Fabiana; Valerio, Matteo; Marra, Fabio; Aburas, Sami; Inghilesi, Andrea L; Cappelli, Alberta; Golfieri, Rita; Mosconi, Cristina; Renzulli, Matteo; Coccoli, Piero; Zamparelli, Marco Sanduzzi
abstract

Background & Aims: Determining risk for recurrence or survival after curative resection or ablation in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) is important for stratifying patients according to expected outcomes in future studies of adjuvant therapy in the era of direct-acting antivirals (DAAs). The aims of this meta-analysis were to estimate the recurrence and survival probabilities of HCV-related early HCC following complete response after potentially curative treatment and to identify predictors of recurrence and survival. Methods: Studies reporting time-dependent outcomes (HCC recurrence or death) after potentially curative treatment of HCV-related early HCC were identified in MEDLINE through May 2016. Data on patient populations and outcomes were extracted from each study by three independent observers and combined using a distribution-free summary survival curve. Primary outcomes were actuarial probabilities of recurrence and survival. Results: Eleven studies met the inclusion criteria. Pooled estimates of actuarial recurrence rates were 7.4% at 6Â months and 47.0% at 2Â years. Pooled estimates of actuarial survival rates were 79.8% at 3Â years and 58.6% at 5Â years. Heterogeneity among studies was highly significant for all outcomes. By univariate meta-regression analyses, lower serum albumin, randomized controlled trial study design and follow-up were independently associated with higher recurrence risk, whereas tumour size and alpha-foetoprotein levels were associated with higher mortality. Conclusions: This meta-analysis showed that recurrence risk and survival are extremely variable in patients with successfully treated HCV-related HCC, providing a useful benchmark for indirect comparisons of the benefits of DAAs and for a correct design of randomized controlled trials in the adjuvant setting.

2017 - Adding Liver Stiffness Measurement to the Routine Evaluation of Hepatocellular Carcinoma Resectability Can Optimize Clinical Outcome [Articolo su rivista]
Cucchetti, Alessandro; Cescon, Matteo; Colecchia, Antonio; Neri, F.; Cappelli, Alberta; Ravaioli, Matteo; Mazzotti, Federico; Ercolani, Giorgio; Festi, Davide; Pinna, ANTONIO DANIELE
abstract

Purpose: Liver stiffness (LS) has been shown to be of use in chronic liver disease patients but its utility in surgical judgment still needs to be proven. A decision-making approach was applied to evaluate whether LS measurement before surgery of hepatocellular carcinoma (HCC) can be useful in avoiding post-hepatectomy liver failure (PHLF). Materials and Methods: Decision curve analysis (DCA) was applied to 202 HCC patients (2008?–?14) with LS measurement prior to hepatectomy to verify whether the occurrence of PHLF grades B/C should be reduced through a decision-making approach with LS. Results: Within 90 days of surgery, 4 patients died (2?%) and grades B/C PHLF occurred in 29.7?% of cases. Ascites and/or pleural effusion, treatable with medical therapy, were the most frequent complications. DCA showed that using the “expected utility theory” LS measurement can reduce up to 39?% of cases of PHLF without the exclusion of any patient from surgery that duly undergoes an uncomplicated postoperative course. LS measurement does not add any information to normal clinical judgment for patients with a low (<?10?%) risk of PHLF. Conclusion: LS measurement can determine a reduction of PHLF under “expected utility theory” fulfilment. However, the degree of PHLF can be minor and “risk seeking” individuals can accept such a risk on the basis of surgical benefits.

2017 - DAAs treatment in HCV recurrence after liver transplantation: Clinical usefulness of non-invasive methods [Abstract in Rivista]
Ravaioli, Federico; Tame', Mariarosa; Marasco, Giovanni; Vizioli, Luca; Morelli, M. C.; Pinna, ANTONIO DANIELE; Conti, Fabio; Andreone, Pietro; Colecchia, Antonio; Festi, Davide
abstract

2017 - DAAs treatment in hepatitis C virus recurrence after Liver Transplantation: clinical usefulness of non-invasive methods [Abstract in Rivista]
Ravaioli, Federico; Tame', Mariarosa; Marasco, Giovanni; Vizioli, Luca; Morelli, M. C.; Pinna, ANTONIO DANIELE; Conti, Fabio; Andreone, Pietro; Colecchia, Antonio; Festi, Davide
abstract

2017 - Differences in liver stiffness values obtained with new ultrasound elastography machines and Fibroscan: A comparative study [Articolo su rivista]
Piscaglia, Fabio; Salvatore, Veronica; Mulazzani, Lorenzo; Cantisani, Vito; Colecchia, Antonio; Di Donato, Roberto; Felicani, Cristina; Ferrarini, Alessia; Gamal, Nesrine; Grasso, Valentina; Marasco, Giovanni; Mazzotta, Elena; Ravaioli, Federico; Ruggieri, Giacomo; Serio, Ilaria; Sitouok Nkamgho, Joules Fabrice; Serra, Carla; Festi, Davide; Schiavone, Cosima; Bolondi, Luigi
abstract

Background and aims Whether Fibroscan thresholds can be immediately adopted for none, some or all other shear wave elastography techniques has not been tested. The aim of the present study was to test the concordance of the findings obtained from 7 of the most recent ultrasound elastography machines with respect to Fibroscan. Methods Sixteen hepatitis C virus-related patients with fibrosis â¥2 and having reliable results at Fibroscan were investigated in two intercostal spaces using 7 different elastography machines. Coefficients of both precision (an index of data dispersion) and accuracy (an index of bias correction factors expressing different magnitudes of changes in comparison to the reference) were calculated. Results Median stiffness values differed among the different machines as did coefficients of both precision (range 0.54â0.72) and accuracy (range 0.28â0.87). When the average of the measurements of two intercostal spaces was considered, coefficients of precision significantly increased with all machines (range 0.72â0.90) whereas of accuracy improved more scatteredly and by a smaller degree (range 0.40â0.99). Conclusions The present results showed only moderate concordance of the majority of elastography machines with the Fibroscan results, preventing the possibility of the immediate universal adoption of Fibroscan thresholds for defining liver fibrosis staging for all new machines.

2017 - Ductal stones recurrence after extracorporeal shock wave lithotripsy for difficult common bile duct stones: Predictive factors [Articolo su rivista]
Muratori, Rosangela; Mandolesi, Daniele; Pierantoni, Chiara; Festi, Davide; Colecchia, Antonio; Mazzella, Giuseppe; Bazzoli, Franco; Azzaroli, Francesco
abstract

Background & purpose Extra-corporeal shock wave lithotripsy (ESWL) can be considered in difficult common bile duct stones (DCBDS), with a success rate greater than 90% but data on stone recurrence after ESWL are limited. We performed a retrospective analysis to evaluate long-term outcomes in patients who underwent ESWL for DCBDS. Methods From May 1992 to October 2012, patients who underwent ESWL treatment for DCBDS, not amenable to endoscopic extraction, were included. Data on long-term outcome were collected through phone interviews and medical records. Results A total of 201 patients with a successful clearance of DCBDS after ESWL were included. During a median follow-up period of 4.64 years, 40 patients (20%) developed a recurrence of bile duct stones. Logistic regression analysis showed that the common bile duct diameter, gallstones presence and the maximum stone size were significantly associated with recurrence. Conclusions We observed a recurrence rate of 20% over a median follow-up of 4 years. Gallbladder stones, stone size and a dilated common bile duct diameter are risk factors for recurrent stone formation, while ursodeoxycholic acid treatment did not influence recurrence in our population.

2017 - Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease [Articolo su rivista]
Barbara, Giovanni; Scaioli, Eleonora; Barbaro, Maria Raffaella; Biagi, Elena; Laghi, Luca; Cremon, Cesare; Marasco, Giovanni; Colecchia, Antonio; Picone, Gianfranco; Salfi, Nunzio; Capozzi, Francesco; Brigidi, Patrizia; Festi, Davide
abstract

OBJECTIVE: The engagement of the gut microbiota in the development of symptoms and complications of diverticular disease has been frequently hypothesised. Our aim was to explore colonic immunocytes, gut microbiota and the metabolome in patients with diverticular disease in a descriptive, cross-sectional, pilot study. DESIGN: Following colonoscopy with biopsy and questionnaire phenotyping, patients were classified into diverticulosis or symptomatic uncomplicated diverticular disease; asymptomatic subjects served as controls. Mucosal immunocytes, in the diverticular region and in unaffected sites, were quantified with immunohistochemistry. Mucosa and faecal microbiota were analysed by the phylogenetic platform high taxonomic fingerprint (HTF)-Microbi.Array, while the metabolome was assessed by 1H nuclear magnetic resonance. RESULTS: Compared with controls, patients with diverticula, regardless of symptoms, had a >70% increase in colonic macrophages. Their faecal microbiota showed depletion of Clostridium cluster IV. Clostridium cluster IX, Fusobacterium and Lactobacillaceae were reduced in symptomatic versus asymptomatic patients. A negative correlation was found between macrophages and mucosal Clostridium cluster IV and Akkermansia. Urinary and faecal metabolome changes in diverticular disease involved the hippurate and kynurenine pathways. Six urinary molecules allowed to discriminate diverticular disease and control groups with >95% accuracy. CONCLUSIONS: Patients with colonic diverticular disease show depletion of microbiota members with anti-inflammatory activity associated with mucosal macrophage infiltration. Metabolome profiles were linked to inflammatory pathways and gut neuromotor dysfunction and showed the ability to discriminate diverticular subgroups and controls. These data pave the way for further large-scale studies specifically aimed at identifying microbiota signatures with a potential diagnostic value in patients with diverticular disease.

2017 - Hepatic decompensation is the major driver of death in HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma [Articolo su rivista]
Cabibbo, G.; Petta, S.; Barbara, M.; Attardo, S.; Bucci, L.; Farinati, F.; Giannini, E. G.; Negrini, G.; Ciccarese, F.; Rapaccini, G. L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Sacco, R.; Virdone, R.; Marra, F.; Mega, A.; Morisco, F.; Benvegnu, L.; Gasbarrini, A.; Svegliati-Baroni, G.; Foschi, F. G.; Olivani, A.; Masotto, A.; Nardone, G.; Colecchia, A.; Persico, M.; Craxi, A.; Trevisani, F.; Camma, C.
abstract

Background & Aims Assessment of long-term outcome is required in hepatitis C virus (HCV)-infected patients with cirrhosis, who have been successfully treated for Barcelona Clinic Liver Cancer (BCLC) stage A hepatocellular carcinoma (HCC). However, problems arise due to the lack of models accounting for early changes during follow-up. The aim of this study was to estimate the impact of early events (HCC recurrence or hepatic decompensation within 12 months of complete radiological response) on 5-year overall survival (OS) in a large cohort of patients with HCV and cirrhosis, successfully treated HCC. Methods A total of 328 consecutive Caucasian patients with HCV-related cirrhosis and BCLC stage 0/A HCC who had complete radiological response after curative resection or thermal ablation were prospectively recruited to this study. Primary endpoint of the study was 5-year OS. Independent baseline and time-dependent predictors of 5-year OS were identified by Cox model. Results The observed 5-year survival rate was 44%. The observed HCC early recurrence and early hepatic decompensation rate were 21% and 10%, respectively. Early hepatic decompensation (Hazard Ratio [HR] 7.52; 95% confidence intervals (CI): 1.23–13.48) and HCC early recurrence as time-dependent covariates (HR 2.50; 95%CI: 1.23–5.05), presence of esophageal varices at baseline (HR 1.66; 95% CI: 1.02–2.70) and age (HR 1.04; 95% CI: 1.02–1.07) were significantly associated with the 5-year OS. Conclusion Survival in HCV-infected patients with cirrhosis and successfully treated HCC is influenced by early hepatic decompensation. Our study indirectly suggests that direct-acting antiviral agents could improve OS of HCC patients through long-term preservation of liver function, resulting in a lower cirrhosis-related mortality and a greater change of receiving curative treatments. Lay summary Survival in hepatitis C virus (HCV) infected patients with cirrhosis and successfully treated hepatocellular carcinoma (HCC), is mainly influenced by early hepatic decompensation. HCV eradication after treatment with new direct-acting antiviral agents could improve overall survival of HCC patients through long-term preservation of liver function.

2017 - Hepatocellular carcinoma recurrence in patients with curative resection or ablation: impact of HCV eradication does not depend on the use of interferon [Articolo su rivista]
Petta, S.; Cabibbo, G.; Barbara, M.; Attardo, S.; Bucci, Laura; Farinati, F.; Giannini, E. G.; Tovoli, Francesco; Ciccarese, Federica; Rapaccini, G. L.; DI MARCO, Mariacristina; Caturelli, E.; Zoli, Marco; Borzio, F.; Virdone, R.; Marra, Fabio; Felder, M.; Morisco, F.; Benvegnù, L.; Gasbarrini, A.; Svegliati Baroni, G.; Foschi, F. G.; Olivani, A.; Masotto, ANDREA-ELEONORA; Nardone, G.; Colecchia, Antonio; Persico, M.; Boccaccio, V.; Craxì, A.; Bruno, Samantha; Trevisani, Franco; Cammà, C.; the Italian Liver Cancer Group:, [. . .; Biselli, Maurizio; Caraceni, Paolo; Cucchetti, Alessandro; Domenicali, Marco; Piscaglia, Fabio; Gramenzi, Annagiulia; Granito, Alessandro; Magalotti, Donatella; Serra, Carla; Negrini, Giulia; Napoli, Lucia; Salvatore, Veronica; Benevento, Francesca; Sacco, ROSALIA ROSALBA; Olmi, S; Dall'Aglio, Ac; Feletti, V; Stefanini, Gf; Golfieri, R; Mosconi, C
abstract

Background: In HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma (HCC), the time to HCC recurrence and the effects of sustained viral eradication (SVR) by interferon (IFN)-based or IFN-free regimens on HCC recurrence remain unclear. Aim: To perform an indirect comparison of time to recurrence (TTR) in patients with successfully treated early HCC and active HCV infection with those of patients with SVR by IFN-based and by IFN-free regimens. Methods: We evaluated 443 patients with HCV-related cirrhosis and Barcelona Clinic Liver Cancer Stage A/0 HCC who had a complete radiological response after curative resection or ablation. Active HCV infection was present in 328, selected from the Italian Liver Cancer group cohort; 58 patients had SVR achieved by IFN-free regimens after HCC cure, and 57 patients had SVR achieved by IFN-based regimens after HCC cure. Individual data of patients in the last two groups were extracted from available publications. Results: TTR by Kaplan–Meier curve was significantly lower in patients with active HCV infection compared with those with SVR both by IFN-free (P = 0.02) and by IFN-based (P < 0.001) treatments. TTR was similar in patients with SVR by IFN-free or by IFN-based (P = 0.49) strategies. Conclusion: In HCV-infected, successfully treated patients with early HCC, SVR obtained by IFN-based or IFN-free regimens significantly reduce tumour recurrence without differences related to the anti-viral strategy used.

2017 - Liver stiffness and serum fibrosis biomarker variations after DAAs treatment: Predictive role in HCC development in cirrhotic patients [Abstract in Rivista]
Ravaioli, F.; Mazzella, G.; Andreone, P.; Conti, F.; Brillanti, S.; Buonfiglioli, F.; Serio, I.; Verucchi, G.; Bacchi Reggiani, M. L.; Marasco, G.; Colecchia, A.; Festi, D.
abstract

2017 - Primary biliary cholangitis-primary sclerosing cholangitis in an evolving overlap syndrome: A case report [Articolo su rivista]
Mandolesi, Daniele; Lenzi, Marco; D'Errico, Antonietta; Festi, Davide; Bazzoli, Franco; Colecchia, Antonio
abstract

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2017 - Spleen stiffness measurement: A useful prognostic tool in HCV patients treated with DAAs regimens [Abstract in Rivista]
Ravaioli, Federico; Marasco, Giovanni; BACCHI REGGIANI, MARIA LETIZIA; Mazzella, Giuseppe; Buonfiglioli, Federica; Porro, Alberto; Brillanti, Stefano; Colecchia, Antonio; Festi, Davide
abstract

2017 - THU-086 - The role of spleen stiffness measurement as predictor of hepatocellular carcinoma recurrence after curative resection in cirrhotic patients [Abstract in Rivista]
Marasco, Giovanni; Colecchia, Antonio; Colli, A.; Casazza, G.; Ravaioli, Federico; Cucchetti, Alessandro; Cescon, Matteo; Pinna, ANTONIO DANIELE; Festi, Davide
abstract

2017 - THU-490 - Spleen stiffness measurement: a useful prognostic tool in HCV patients treated with DAAs regimens [Abstract in Rivista]
Ravaioli, Federico; Marasco, Giovanni; BACCHI REGGIANI, MARIA LETIZIA; Mazzella, Giuseppe; Buonfiglioli, Federica; Porro, Alberto; Brillanti, Stefano; Colecchia, Antonio; Festi, Davide
abstract

2017 - THU-492 - Liver stiffness and serum fibrosis biomarker variations after DAAs treatment: predictive role in hepatocellular carcinoma development in in cirrhotic patients [Abstract in Rivista]
Ravaioli, Federico; Mazzella, Giuseppe; Andreone, Pietro; Conti, Fabio; Brillanti, Stefano; Buonfiglioli, Federica; Serio, Ilaria; Verucchi, Gabriella; BACCHI REGGIANI, MARIA LETIZIA; Marasco, Giovanni; Colecchia, Antonio; Festi, Davide
abstract

2017 - The evolutionary scenario of hepatocellular carcinoma in Italy: an update [Articolo su rivista]
Bucci, L.; Garuti, F.; Lenzi, B.; Pecorelli, A.; Farinati, F.; Giannini, E. G.; Granito, A.; Ciccarese, F.; Rapaccini, G. L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Sacco, R.; Camma, C.; Virdone, R.; Marra, F.; Felder, M.; Morisco, F.; Benvegnu, L.; Gasbarrini, A.; Svegliati-Baroni, G.; Foschi, F. G.; Missale, G.; Masotto, A.; Nardone, G.; Colecchia, A.; Bernardi, M.; Trevisani, F.
abstract

Background & Aims: Epidemiology of hepatocellular carcinoma is changing worldwide. This study aimed at evaluating the changing scenario of aetiology, presentation, management and prognosis of hepatocellular carcinoma in Italy during the last 15 years. Methods: Retrospective analysis of the ITA.LI.CA (Italian Liver Cancer) database including 5192 hepatocellular carcinoma patients managed in 24 centres from 2000 to 2014. Patients were divided into three groups according to the date of cancer diagnosis (2000–2004, 2005–2009 and 2010–2014). Results: The main results were as follows: (i) progressive patient aging; (ii) progressive expansion of non-viral cases and, namely, of “metabolic” hepatocellular carcinomas; (iii) increasing proportion of hepatocellular carcinoma diagnosed during a correct (semi-annual) surveillance programme; (iv) favourable cancer stage migration; (v) increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) improved overall survival (adjusted for the lead time in surveyed patients), particularly after 2009, of both viral and non-viral patients presenting with an early- or intermediate-stage hepatocellular carcinoma. Conclusions: During the last 15 years several aetiological and clinical features of hepatocellular carcinoma patients have changed, as their management. The observed improvement of overall survival was owing both to the wider use of semi-annual surveillance, expanding the proportion of tumours that qualified for curative treatments, and to the improved outcome of loco-regional treatments.

2017 - The role of Spleen Stiffness measurement as predictor of HCC recurrence after curative resection in cirrhotic patients [Abstract in Rivista]
Marasco, G.; Colecchia, A.; Colli, A.; Casazza, G.; Ravaioli, F.; Cucchetti, A.; Cescon, M.; Pinna, A. D.; Festi, D.
abstract

Introduction: Hepatocellular carcinoma (HCC) is a frequent complication in patients with chronic liver diseases and one of the most common malignancies worldwide. Liver resection is the gold standard treatment option for patients with solitary tumors; however, tumor recurrence complicates 70% of cases of hepatic resection at 5 years. Recently it has been demonstrated that the degree of portal hypertension (PH) measured by HVPG is directly correlated with the risk of developing HCC. We recently documented that spleen (SSM) and liver (LSM) stiffness measurement are accurate non-invasive markers of portal hypertension in cirrhosis. Aims: The aim of our study was to identify the role of SSM and LSM as predictors of HCC recurrence after curative resection. Materials and methods/Results: 157 patients with HCC who underwent curative resection between 2008 and 2014 were prospectively enrolled to assess early (<12 months) and late (>24 months) recurrence. The results of LSM and SSM assessed with TE (Fibroscan®, Echosens) together with clinical and histological data were collected before surgery and their association with early or late recurrence was assessed by uni and multivariate logistic regression analysis. Forty-nine (49) patients with early and 22 with late HCC recurrence were identified during follow-up period. At univariate analysis, early recurrences were associated with etiology, number of nodules, HCC diameter and grading, infiltrated resection margins and satellitosis. Multivariate analysis showed that only viral (HCV, HBV) etiology, tumor diameter and margin infiltration were independently associated with early recurrence with an area under the curve (AUC) of 0.73. At univariate analysis late recurrence was associated only with SSM (p = 0.0027) with an AUC of 0.70. Conclusions: Early HCC recurrence is associated with HCC clinical and pathological features; late recurrence was best predicted by the assessment of SSM, thus suggesting a role of portal hypertension in the development of HCC late recurrence.

2017 - Usefulness of liver stiffness measurement in predicting hepatic veno-occlusive disease development in patients who undergo HSCT [Articolo su rivista]
Colecchia, Antonio; Marasco, Giovanni; Ravaioli, Federico; Kleinschmidt, Katharina; Masetti, Riccardo; Prete, Arcangelo; Pession, Andrea; Festi, Davide
abstract

Hepatic veno-occlusive disease (VOD), or sinusoidal obstructive syndrome (SOS), is a clinical syndrome characterized by hepato-megaly, ascites, weight gain and jaundice, which can develop more frequently in the first 30 days after hematopoietic stem cell transplantation (HSCT). Its incidence, although in fluenced by diagnostic criteria, has been estimated to be 13.7% (range 0 – 62.3%) and, in untreated hepatic severe VOD/SOS, it is associated with > 80% mortality. In this syndrome, sinusoidal endothelial cells and hepatocytes in zone 3 of the hepatic acinus are damaged by toxic metabolites generated during the conditioning regimen. The classic VOD pathway develops by the narrowing of the sinusoids, embolization of endothelial cells and increased clot formation, leading to obstruction of the sinusoids, subendothelial and centro-acinar fibrosis and then to portal- central fibrosis resulting in post-sinusoidal portal hypertension, which dominates the clinical picture.

2016 - Are noninvasive methods clinically useful in advanced, decompensated liver cirrhosis when "les Jeux Sont Faits"? [Articolo su rivista]
Colecchia, Antonio; Marasco, Giovanni; Festi, Davide
abstract

2016 - Encefalopatia epatica [Articolo su rivista]
Festi, Davide; Marasco, Giovanni; Ravaioli, Federico; Colecchia, Antonio
abstract

Hepatic encephalopathy (HE) is a common complication of liver cirrhosis and it can manifest with a broad spectrum of neuropsychiatric abnormalities of varying severity, acuity and time course with important clinical implications. According to recent guidelines, HE has been classified into different types, depending on the severity of hepatic dysfunction, the presence of porto-systemic shunts and the number of previous episodes or persistent manifestations. From a clinical point of view, HE can be recognized as unimpaired, covert (that deals with minimal and grade 1 according to the grading of mental state), and overt (that is categorized from grade 2 to grade 4). Different and only partially known pathogenic mechanisms have been identified, comprising ammonia, inflammatory cytokines, benzodiazepine-like compounds and manganese deposition. Different therapeutic strategies are available for treating HE, in particular the overt HE, since covert HE needs to be managed case by case. Recognition and treatment of precipitating factors represent fundamental part of the management. The more effective treatments, which can be performed separately or combined, are represented by non-absorbable disaccharides (lactulose and lactitol) and the topic antibiotic rifaximin; other possible therapies, mainly used in patients non responders to previous treatments, are represented by branched chain amino acids and metabolic ammonia scavengers.

2016 - Gut Microbiota and Celiac Disease. [Articolo su rivista]
Marasco, G; Di Biase, Ar; Schiumerini, R; Eusebi, Lh; Iughetti, Lorenzo; Ravaioli, F; Scaioli, E; Colecchia, A; Festi, D.
abstract

Recent evidence regarding celiac disease has increasingly shown the role of innate immunity in triggering the immune response by stimulating the adaptive immune response and by mucosal damage. The interaction between the gut microbiota and the mucosal wall is mediated by the same receptors which can activate innate immunity. Thus, changes in gut microbiota may lead to activation of this inflammatory pathway. This paper is a review of the current knowledge regarding the relationship between celiac disease and gut microbiota. In fact, patients with celiac disease have a reduction in beneficial species and an increase in those potentially pathogenic as compared to healthy subjects. This dysbiosis is reduced, but might still remain, after a gluten-free diet. Thus, gut microbiota could play a significant role in the pathogenesis of celiac disease, as described by studies which link dysbiosis with the inflammatory milieu in celiac patients. The use of probiotics seems to reduce the inflammatory response and restore a normal proportion of beneficial bacteria in the gastrointestinal tract. Additional evidence is needed in order to better understand the role of gut microbiota in the pathogenesis of celiac disease, and the clinical impact and therapeutic use of probiotics in this setting.

2016 - Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma [Articolo su rivista]
Cucchetti, Alessandro; Cescon, Matteo; Golfieri, Rita; Piscaglia, Fabio; Renzulli, Matteo; Neri, Flavia; Cappelli, Alberta; Mazzotti, Federico; Mosconi, Cristina; Colecchia, Antonio; Ercolani, Giorgio; Pinna, Antonio Daniele
abstract

BACKGROUNDS & AIMS: To assess the relationship existing between hepatic venous pressure gradient (HVPG) and the occurrence of post-hepatectomy liver failure (PHLF) grade B/C after resection of hepatocellular carcinoma (HCC) and persistent worsening of liver function. METHODS: Data from 70 consecutive prospectively enrolled HCC patients undergoing resection were collected and analysed. PHLF grade B/C was defined by the International Study Group of Liver Surgery recommendations. The appearance of unresolved decompensation was also analysed. RESULTS: Postoperative and 90-day mortality were null. The median HVPG value was 9mmHg (range: 4-18) and the median Model for End-stage Liver Disease (MELD) score was 8 (range: 6-14); 34 patients had an HVPG ⩾10mmHg (48.6%). Forty-nine patients had an uneventful (Grade A) postoperative course, including 17 with an HVPG ⩾10mmHg (24.2% of 70 patients). Grade B complications occurred in 20 patients (3 with an HVPG <10mmHg and 17 with an HVPG ⩾10mmHg; p<0.001); only one grade C complication occurred in a patient with an HVPG <10mmHg, subsequently successfully undergoing liver transplantation. Median MELD score returned to preoperative values after a transient postoperative increase, regardless of the HVPG values; after three months, it returned to the preoperative of 8 in patients with an HVPG <10mmHg and of 9 in patients with an HVPG ⩾10mmHg (p=0.077 and 0.076 at paired test, respectively). CONCLUSIONS: The hepatic venous pressure gradient can be used before surgery to stratify the risk of PHLF but the proposed cut-off of 10mmHg excludes approximately one-quarter of the patients who would benefit from surgery without short to mid-term postoperative sequelae.

2016 - MRI patterns in a case of 6-thioguanine-related hepatic sinusoidal obstruction syndrome [Articolo su rivista]
Marasco, Giovanni; Scaioli, Eleonora; Renzulli, Matteo; Colecchia, Antonio; Golfieri, Rita; Festi, Davide; Bazzoli, Franco; Digby, Richard John; Belluzzi, Andrea
abstract

non disponibile

2016 - Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon [Articolo su rivista]
Scaioli, Eleonora; Colecchia, Antonio; Marasco, Giovanni; Schiumerini, Ramona; Festi, Davide
abstract

Colonic diverticulosis imposes a significant burden on industrialized societies. The current accepted causes of diverticula formation include low fiber content in the western diet with decreased intestinal content and size of the lumen, leading to the transmission of muscular contraction pressure to the wall of the colon, inducing the formation of diverticula usually at the weakest point of the wall where penetration of the blood vessels occurs. Approximately 20 % of the patients with colonic diverticulosis develop abdominal symptoms (i.e., abdominal pain and discomfort, bloating, constipation, and diarrhea), a condition which is defined as symptomatic uncomplicated diverticular disease (SUDD). The pathogenesis of SUDD symptoms remains uncertain and even less is known about how to adequately manage bowel symptoms. Recently, low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to symptom development, thus changing and improving the therapeutic approach. In this review, a comprehensive search of the literature regarding on SUDD pathogenetic hypotheses and pharmacological strategies was carried out. The pathogenesis of SUDD, although not completely clarified, seems to be related to an interaction between colonic microbiota alterations, and immune, enteric nerve, and muscular system dysfunction (Cuomo et al. in United Eur Gastroenterol J 2:413-442, 2014). Greater understanding of the inflammatory pathways and gut microbiota composition in subjects affected by SUDD has increased therapeutic options, including the use of gut-directed antibiotics, mesalazine, and probiotics (Bianchi et al. in Aliment Pharmacol Ther 33:902-910, 2011; Comparato et al. in Dig Dis Sci 52:2934-2941, 2007; Tursi et al. in Aliment Pharmacol Ther 38:741-751, 2013); however, more research is necessary to validate the safety, effectiveness, and cost-effectiveness of these interventions.

2016 - Relationship between indocyanine green retention test, decompensation and survival in patients with Child-Pugh A cirrhosis and portal hypertension [Articolo su rivista]
Lisotti, A.; Azzaroli, F.; Cucchetti, A.; Buonfiglioli, F.; Cecinato, P.; Calvanese, C.; Simoni, P.; Arena, R.; Montagnani, M.; Golfieri, R.; Colecchia, A.; Festi, D.; Mazzella, G.
abstract

Background & Aims: Indocyanine green retention test (ICG-r15) is a non-invasive marker of functional hepatic reserve. Among patients with compensated cirrhosis, ICG-r15 correlates to the degree of portal hypertension (PH); however, its prognostic relationship with the occurrence of decompensation events still requires clarification. Methods: ICG-r15 was prospectively measured in 154 patients with compensated cirrhosis. Patients with hepatocellular carcinoma (HCC), Child–Pugh B-C, MELD>15, bilirubin > 2 mg/dl, INR > 1.5 or portal vein thrombosis were excluded. All patients underwent laboratory tests, upper endoscopy and hepatic venous pressure gradient (HVPG). Decompensation, development of HCC, liver transplant and death were recorded and analysed through competing-risk analysis. Results: The study group was composed of 134 patients who were followed for a median of 39 months. During follow-up, 46 patients (34.3%) developed liver decompensation. Hepatocellular carcinoma occurred in 18 patients and two patients died from non-liver-related causes. The 1-, 2- and 3-year cumulative incidences of decompensation were 9.7%, 28.4% and 33.4% respectively. Patients with ICG-r15 < 10% did not experience any decompensation events during follow-up, while the 3-year cumulative incidence of decompensation of patients with ICG-r15 between 10% and 22.9% was 29.2% and that of patients with ICG-r15 ≥ 23% was 70.0% (P < 0.001). ICG-r15 gave the lowest pseudo-log-likelihood value, in comparison to oesophageal varices present, MELD, low platelet count and HVPG. Conclusions: ICG-r15 appears to be strictly related to liver decompensation, longitudinally confirming the preliminary findings of its correlation with PH among patients with compensated cirrhosis, and can be used for patient prognostication.

2015 - Adverse Food Reaction and Functional Gastrointestinal Disorders: Role of the Dietetic Approach [Articolo su rivista]
Pasqui, Francesca; Poli, Carolina; Colecchia, Antonio; Marasco, Giovanni; Festi, Davide
abstract

Bloating, abdominal discomfort or pain, disturbed bowel habits are very common symptoms, frequently reported by the patients soon after food ingestion. These symptoms may occur in different clinical conditions, such as functional bowel disorders, food adverse reactions, gluten-related syndromes, which frequently are interrelated. Consequently, in clinical practice, it is necessary to perform a correct diagnosis in order to identify, for the single patient, the most appropriate therapeutic strategy, which may include not only specific drugs, but also, and mainly, life style changes (healthy nutritional behavior and constant physical activity). The aim of this review is to provide to the general physician, according to the available evidence, the most appropriate diagnostic work-ups for recognizing the different clinical scenarios (i.e. food allergy and intolerance, functional bowel diseases, gluten-related syndromes), to identify their clinical interrelationships and to suggest the most appropriate management. In fact, as far as food intolerances are concerned, it is well known that the number of patients who believe that their symptoms are related to food intolerance is increasing and consequently they restrict their diet, possibly causing nutritional deficiencies. Furthermore, there is an increasing use of unconventional diagnostic tests for food intolerance which lack accurate scientific evidence; the application of their results may induce misdiagnosis and unhealthy therapeutic choices. Consequently the recognition of food intolerance has to be performed on the basis of reliable tests within an agreed diagnostic workup.

2015 - Dysbiosis in Celiac disease patients with persistent symptoms on gluten-free diet: a condition similar to that present in irritable bowel syndrome patients? [Articolo su rivista]
Marasco, Giovanni; Colecchia, Antonio; Festi, Davide
abstract

Comment on: Altered duodenal microbiota composition in celiac disease patients suffering from persistent symptoms on a long-term gluten-free diet. [Am J Gastroenterol. 2014]

2015 - Extrahepatic cholangiocarcinoma: clinical features [Capitolo/Saggio]
Festi, Davide; Scaioli, Eleonora; Colecchia, Antonio
abstract

Extrahepatic cholangiocarcinomas (E-CCAs), are hepatobiliary cancers with features of cholangiocyte differentiations, originating from extrahepatic biliary tree at the bifurcation of the hepatic ducts and also in the distal duct. E-CCAs represent the most common type of cholangiocarcinomas (CCAs) and are characterized by poor overall survival. The principal risk factors for E-CCAs are strictly related to geographic location. Jaundice is the most common physical sign at disease presentation. Other common more non-specific symptoms include hepatomegaly, right upper qudrant mass, weight loss, vomiting, nausea, diarrhoea, malaise and fatigue. Unlike intrahepatic CCA, an incidental asymptomatic presentation occurs in a small percentage of cases. This chapter evaluates the principal clinical features of E-CCAs, briefly discussing its specific risk factors.

2015 - IMPULSIONAL, POINT AND BIDIMENSIONAL SHEAR WAVE ELASTOMETRY FOR PORTAL HYPERTENSION: SAME STIFFNESS THRESHOLDS? [Abstract in Rivista]
Stefanescu, HORIA OCTAVIAN; Allegretti, Giulia; Serra, Carla; Marasco, Giovanni; Gamal, N.; Conti, Fabio; Colecchia, Antonio; Festi, Davide; Andreone, Pietro; Bolondi, Luigi; Piscaglia, Fabio
abstract

2015 - Ischaemia-modified albumin: a marker of bacterial infection in hospitalized patients with cirrhosis [Articolo su rivista]
Giannone, Fa; Domenicali, M; Baldassarre, M; Bartoletti, M; Naldi, M; Laggetta, M; Bertucci, C; Colecchia, A; Viale, P; Bernardi, M; Caraceni, P
abstract

2015 - Liver and spleen stiffness and other noninvasive methods to assess portal hypertension in cirrhotic patients: a review of the literature [Articolo su rivista]
Colecchia, Antonio; Marasco, Giovanni; Taddia, Martina; Montrone, Lucia; Eusebi, LEONARDO HENRY UMBERTO; Mandolesi, Daniele; Schiumerini, Ramona; Di Biase, Anna R; Festi, Davide
abstract

Portal hypertension (PH) is one of the most important causes of morbidity and mortality in patients with chronic liver disease. PH measurement is crucial to stage and predict the clinical outcome of liver cirrhosis. Measurement of hepatic vein pressure gradient is considered the gold standard for assessment of the degree of PH; however, it is an invasive method and has not been used widely. Thus, noninvasive methods have been proposed recently. We critically evaluated serum markers, abdominal ultrasonography, and particularly liver and spleen stiffness measurement, which represent the more promising methods to stage PH degree and to assess the presence/absence of esophageal varices (EV). A literature search was carried out on MEDLINE, EMBASE, Web of Science, and Scopus for articles and abstracts. The search terms used included 'liver cirrhosis', 'portal hypertension', 'liver stiffness', 'spleen stiffness', 'ultrasonography', and 'portal hypertension serum biomarker'. The articles cited were selected on the basis of their relevance to the objective of the review. The results of available studies indicate that individually, these methods have a mild accuracy in predicting the presence of EV, and thus they cannot substitute endoscopy to predict EV. When these tests were used in combination, their accuracy increased. In addition to the PH staging, several serum markers and spleen stiffness measurement can predict the clinical outcome of liver cirrhosis with a good accuracy, comparable to that of hepatic vein pressure gradient. In the future, noninvasive methods could be used to select patients requiring further investigations to identify the best tailored clinical management.

2015 - Non-invasive diagnostic approach to non-alcoholic fatty liver disease: current evidence and future perspectives [Articolo su rivista]
Festi, D; Schiumerini, R; Marasco, G; Scaioli, E; Pasqui, F; Colecchia, A
abstract

Non-alcoholic fatty liver disease is a new epidemic liver disease, thus, its early diagnosis and the identification of those patients with the worst prognosis is mandatory. Liver biopsy is still the diagnostic gold standard, even if it is associated to a significant rate of complications; moreover, the interpretation of histological samples is not always univocal. Several non-invasive alternative scores have been proposed for the diagnostic approach to non-alcoholic fatty liver disease. This article evaluates the performance of the currently available non-invasive diagnostic strategies. The authors also suggest a potential diagnostic algorithm, with two or more non-invasive techniques, to increase the overall accuracy for identifying patients with worst prognosis, and to minimize the recourse to liver biopsy.

2015 - Reply to Letter:'Value of transient elastography measured by Fibroscan in predicting the outcome of hepatic resection for hepatocellular carcinoma' [Articolo su rivista]
Cescon, Matteo; Cucchetti, Alessandro; Colecchia, Antonio; Ercolani, Giorgio; Festi, Davide; Pinna, Antonio Daniele
abstract

Reply to letter: "value of transient elastography measured with fibroscan in predicting the outcome of hepatic resection for hepatocellular carcinoma".

2015 - Risk factors for gallstone formation during weight loss [Articolo su rivista]
Festi, D; Villanova, N; Colecchia, A
abstract

Risk factors for gallstone formation during weight loss

2015 - The Onset of de novo Hepatocellular Carcinoma after Liver Transplantation can be both of Donor and Recipient origin. A Case Report [Articolo su rivista]
Tame', Mariarosa; Calvanese, Claudio; Cucchetti, Alessandro; Gruppioni, Elisa; Colecchia, Antonio; Bazzoli, Franco
abstract

The occurrence of de novo hepatocellular carcinoma after liver transplantation is a rare event with only few cases reported in the literature. In a post liver transplantation setting distinguishing between a de novo hepatocellular carcinoma from recurrence should be tested with molecular analysis such as fluorescent in situ hybridization (for sex chromosomes) or microsatellite analysis. Nevertheless, a certain degree of epithelial chimerism between recipient and donor tissues could be responsible for the development of de novo hepatocellular carcinoma of recipient origin. We report two cases of de novo hepatocellular carcinoma after liver transplantation. The first one occurred in a patient receiving transplantation for hepatitis C related cirrhosis and hepatocellular carcinoma. A de novo hepatocellular carcinoma developed five years after transplantation and microsatellite analysis revealed the donor origin of the neoplasia. The second one occurred in a patient who received transplantation for secondary sclerosing cholangitis. Hepatocellular carcinoma was found six years after transplantation. Both microsatellite analysis and fluorescent in situ hybridization revealed the recipient origin of the tumor, potentially due to tissue chimerism.

2015 - Transient Elastography (FibroScan) Is Not Correlated With Liver Fibrosis but With Cholestasis in Patients With Long-Term Home Parenteral Nutrition [Articolo su rivista]
Van Gossum, A; Pironi, L; Messing, B; Moreno, C; Colecchia, A; D'Errico A, ; Demetter, P; De Gos, F; Cazals-Halem, D; Joly, F
abstract

Background: Long-term home parenteral nutrition (HPN) may induce liver disorders. Transient elastography (TE) has been proposed as a noninvasive alternative to liver biopsy analysis for assessment of the progression of hepatic fibrosis to cirrhosis. The goal of this study was to compare values from TE measurements to biopsy-determined stages of histologic fibrosis in patients receiving HPN. Methods: In this multicenter prospective study, patients receiving long-term HPN (‰6 months) who required a liver biopsy for clinical reasons were included. TE (FibroScan) values for each patient were compared with the degree of hepatic fibrosis measured from biopsy specimens based on the Brunt classification. TE values were also correlated to biochemical and histologic cholestasis. Two noninvasive indices for predicting liver fibrosis (APRI and FIB-4) were also evaluated. Results: Thirty patients were included in this study (mean age, 42.1 years; 63% male). The mean duration of HPN was 100.7 months; 25 patients had a short bowel and 13 had an intestinal stoma. Biochemical cholestasis was described in 22 patients. Liver histologic features varied among these patients. There was no correlation between the values of TE and the stages of histologic fibrosis, but TE values were significantly correlated to serum bilirubin level and the severity of histologic cholestasis as well as APRI and FIB-4 scores. Conclusions: In patients with long-term HPN, TE failed to assess the degree of hepatic fibrosis. This could be due to the heterogeneity of liver histologic features observed in these patients and the presence of chronic cholestasis.

2014 - An explorative data-analysis to support the choice between hepatic resection and radiofrequency ablation in the treatment of hepatocellular carcinoma [Articolo su rivista]
Cucchetti, Alessandro; Piscaglia, Fabio; Cescon, Matteo; Serra, Carla; Colecchia, Antonio; Maroni, Lorenzo; Venerandi, Laura; Ercolani, Giorgio; Pinna, ANTONIO DANIELE
abstract

Whether to prefer hepatic resection or radiofrequency ablation as first line therapy for hepatocellular carcinoma is a matter of debate.To compare outcomes of resection and ablation, in the treatment of early hepatocellular carcinoma, through a decision-making analysis.Data of 388 cirrhotic patients undergoing resection and of 207 undergoing radiofrequency ablation were reviewed. Two distinct regression models were devised and used to perform sensitivity and probabilistic analyses, to overcome biases of covariate distributions.Actuarial survival curves showed no difference between resection and ablation (P=0.270) despite the fact that ablated patients were older, with worse liver function and smaller, unifocal tumours (P<0.05), suggesting a complex, non-linear relationship between clinical, tumoral variables and treatments. Sensitivity and probabilistic analyses suggested that the superiority of resection over ablation decreased at higher Model for-End stage Liver Disease scores, and that ablation provided better results for smaller tumours and higher Model for-End stage Liver Disease scores. In patients with 2-3 tumours up to 3cm, the two treatments produced opposite comparative results in relation to the Model for-End stage Liver Disease score.The superiority, or the equivalence, of resection and ablation depends on the non-linear relationship existing between treatment, tumour number, size and degree of liver dysfunction.

2014 - Gut microbiota and metabolic syndrome [Articolo su rivista]
Festi, D; Schiumerini, R; Eusebi, Lh; Marasco, G; Taddia, M; Colecchia, A
abstract

Gut microbiota exerts a significant role in the pathogenesis of the metabolic syndrome, as confirmed by studies conducted both on humans and animal models. Gut microbial composition and functions are strongly influenced by diet. This complex intestinal "superorganism" seems to affect host metabolic balance modulating energy absorption, gut motility, appetite, glucose and lipid metabolism, as well as hepatic fatty storage. An impairment of the fine balance between gut microbes and host's immune system could culminate in the intestinal translocation of bacterial fragments and the development of "metabolic endotoxemia", leading to systemic inflammation and insulin resistance. Diet induced weight-loss and bariatric surgery promote significant changes of gut microbial composition, that seem to affect the success, or the inefficacy, of treatment strategies. Manipulation of gut microbiota through the administration of prebiotics or probiotics could reduce intestinal low grade inflammation and improve gut barrier integrity, thus, ameliorating metabolic balance and promoting weight loss. However, further evidence is needed to better understand their clinical impact and therapeutic use

2014 - Indocyanine green retention test as a noninvasive marker of portal hypertension and esophageal varices in compensated liver cirrhosis [Articolo su rivista]
Lisotti, A; Azzaroli, F; Buonfiglioli, F; Montagnani, M; Cecinato, P; Turco, L; Calvanese, C; Simoni, P; Guardigli, M; Arena, R; Cucchetti, A; Colecchia, A; Festi, D; Golfieri, R; Mazzella, G
abstract

2014 - Italian consensus conference for colonic diverticulosis and diverticular disease [Articolo su rivista]
Cuomo, Rosario; Barbara, Giovanni; Pace, Fabio; Annese, Vito; Bassotti, Gabrio; Binda, Gian Andrea; Casetti, Tino; Colecchia, Antonio; Festi, Davide; Fiocca, Roberto; Laghi, Andrea; Maconi, Giovanni; Nascimbeni, Riccardo; Scarpignato, Carmelo; Villanacci, Vincenzo; Annibale, Bruno
abstract

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.

2014 - Prognostic factors for hepatocellular carcinoma recurrence [Articolo su rivista]
Colecchia, Antonio; Schiumerini, Ramona; Cucchetti, Alessandro; Cescon, Matteo; Taddia, Martina; Marasco, Giovanni; Festi, Davide
abstract

The recurrence of hepatocellular carcinoma, the sixth most common neoplasm and the third leading cause of cancer-related mortality worldwide, represents an important clinical problem, since it may occur after both surgical and medical treatment. The recurrence rate involves 2 phases: an early phase and a late phase. The early phase usually occurs within 2 years after resection; it is mainly related to local invasion and intrahepatic metastases and, therefore, to the intrinsic biology of the tumor. On the other hand, the late phase occurs more than 2 years after surgery and is mainly related to de novo tumor formation as a consequence of the carcinogenic cirrhotic environment. Since recent studies have reported that early and late recurrences may have different risk factors, it is clinically important to recognize these factors in the individual patient as soon as possible. The aim of this review was, therefore, to identify predicting factors for the recurrence of hepatocellular carcinoma, by means of invasive and non-invasive methods, according to the different therapeutic strategies available. In particular the role of emerging techniques (e.g., transient elastography) and biological features of hepatocellular carcinoma in predicting recurrence have been discussed. In particular, invasive methods were differentiated from non-invasive ones for research purposes, taking into consideration the emerging role of the genetic signature of hepatocellular carcinoma in order to better allocate treatment strategies and surveillance follow-up in patients with this type of tumor.

2014 - Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma [Articolo su rivista]
Golfieri, R; Giampalma, E; Renzulli, M; Cioni, R; Bargellini, I; Bartolozzi, C; Breatta, Ad; Gandini, G; Nani, R; Gasparini, ; Cucchetti, A; Bolondi, L; Trevisani, F; PRECISION ITALIA STUDY GROUP., Collaborators: Mosconi C; Cappelli, A; Galaverni, Mc; Pini, P; Piscaglia, F; Benevento, F; Giampaolo, L; Caprara, C; Menichella, R; Lenzi, M; Bernardi, M; Santi, V; Erroi, V; Mazzella, G; Colecchia, A; Montrone, L; Schiumerini, R; Bianchi, G; Zoli, M; Martini, G; Fraticelli, L; Sama, C; Berardi, S; Serra, C; Vignali, C; Bianchi, F; Vallini, V; Carrai, P; Filipponi, F; Moneta, S; Pea, E; Giunta, S; Sacco, R; Ricchiuti A, ; di Fluri, G; Coco, B; Rossato, D; Vighetti, C; Battisti, G; Rapellino, A; Carucci, P; Cosso, L; Rizzetto, M; Mirabella, S; Sturniolo, L; Catalano, G; Salizzoni, M; Agazzi, R; Limonta, S; Fagiuoli, S; Verga, G; Magini, G; Aprile, G; Vit, A.
abstract

2014 - Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: a prospective study [Articolo su rivista]
Colecchia, A; Colli, A; Casazza, G; Mandolesi, D; Schiumerini, R; Reggiani, Lb; Marasco, G; Taddia, M; Lisotti, A; Mazzella, G; Di Biase, Ar; Golfieri, R; Pinzani, M; Festi, D
abstract

Hepatic venous pressure gradient (HVPG) measurement represents the best predictor of clinical decompensation (CD) in cirrhotic patients. Recently data show that measurement of spleen stiffness (SS) has an excellent correlation with HVPG levels. Aim of the present prospective study was to assess SS predictive value for CD compared to HVPG, liver stiffness (LS), and other non-invasive tests for portal hypertension in a cohort of patients with HCV-related compensated cirrhosis.

2013 - A new point-of-care portable immunosensor for non-invasive assessment of oro-ileal transit time by oral fluid tauroursodeoxycholate measurement after its oral load [Articolo su rivista]
Simoni, Patrizia; Magliulo, Maria; Mirasoli, Mara; Vestito, Amanda; Festi, Davide; Roda, Giulia; Colecchia, Antonio; Roda, Aldo
abstract

A non-invasive test for oro-ileal transit time (OITT) evaluation was developed, based on the measurement of tauroursodeoxycholic acid (TUDCA) oral fluid concentration profile after its oral administration. Exploiting the fact that TUDCA is actively absorbed only in the ileum, OITT is measured as the time corresponding to TUDCA maximum oral fluid concentration (tmax).To measure oral fluid TUDCA concentration in a point-of-care setting, an ultrasensitive portable immunosensor was developed, based on a competitive chemiluminescent enzyme immunoassay (CL-EIA), using immobilized anti-TUDCA antibody and an ursodeoxycholic acid (UDCA)-peroxidase conjugate as tracer, detected by enhanced chemiluminescence employing a portable charge-coupled device (CCD)-based device. The test was validated in 24 healthy subjects before and after treatment with Loperamide, a drug that increases OITT.The developed CL-EIA was accurate and precise, with a LLOQ of 50pmolL-1. The measured OITT for healthy subjects (291±50min) was fairly well correlated with OITT values obtained by measuring TUDCA in serum (r=0.89). An increased OITT was observed in all the studied subjects after Loperamide treatment.The CL immunosensor can be employed directly in gastroenterology and paediatric units and it can thus represent a new non-invasive simple test for OITT evaluation in a point-of-care setting, with improved diagnostic utility

2013 - Benign hepatic nodular lesions after treatment for childhood cancer [Articolo su rivista]
Masetti, Riccardo; Colecchia, Antonio; Rondelli, Roberto; Martoni, Anna; Vendemini, F; Biagi, Carlotta; Prete, Arcangelo; Festi, Davide; Lima, Mario; Pession, Andrea
abstract

BACKGROUND:: Benign nodular hepatic regenerating lesions such as focal nodular hyperplasia (FNH) have been reported as rare complications of the antineoplastic therapy received during infancy. Little is known about the risk factors associated with the onset of these lesions and their diagnostic management. METHODS:: We have analyzed a series of benign hepatic nodular lesions occurring in children previously treated for malignant tumors in our institution in a period of 11 years. An extensive description of the imaging presentation of the lesions has been provided to facilitate the differential diagnosis, and a risk factor analysis has been conducted. RESULTS:: A total of 14 diagnoses (10 FNH and 4 hemangiomas) of benign nodular hepatic lesions have been found. Hematopoietic stem cell transplantation is the most important statistically independent risk factor associated with the development of these lesions, especially for FNH. No malignant transformation of nodules has been recorded during a median follow-up time of 4 years. CONCLUSIONS:: In our experience, FNH is the most frequent benign nodular hepatic lesions occurring after treatment for childhood cancer. Hematopoietic stem cell transplantation is the most important risk factor to be taken in account. After a secure diagnosis of these benign lesions, only a close imaging follow-up is recommended.

2013 - Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma [Articolo su rivista]
Cucchetti, Alessandro; Piscaglia, Fabio; Cescon, Matteo; Colecchia, Antonio; Ercolani, Giorgio; Bolondi, Luigi; Pinna, Antonio Daniele
abstract

BACKGROUND & AIMS: Both hepatic resection and radiofrequency ablation (RFA) are considered curative treatments for hepatocellular carcinoma (HCC), but their economic impact still remains not determined. Aim of the present study was to analyze the cost-effectiveness (CE) of these two strategies in early stage HCC (Milan criteria). METHODS: As first step, a meta-analysis of the pertinent literature of the last decade was performed. Seventeen studies fulfilled the inclusion criteria: 3,996 patients underwent resection and 4,424 underwent RFA for early HCC. Data obtained from the meta-analysis were used to construct a Markov model. Costs were assessed from the health care providers perspective. A Monte-Carlo probabilistic sensitivity analysis was used to estimate outcomes with distribution samples of 1,000 patients for each treatment arm. RESULTS: In a 10 year perspective, for very early HCC (single nodule <2cm) in Child-Pugh class A patients, RFA provided similar life-expectancy and quality-adjusted life-expectancy at a lower cost than resection and was the most cost-effective therapeutic strategy. For single HCCs of 3-5cm, resection provided better life-expectancy and was more cost-effective than RFA, at a willingness-to-pay above €4,200 per quality-adjusted life-year. In the presence of two or three nodules ⩽3cm, life-expectancy and quality-adjusted life-expectancy were very similar between the two treatments, but cost-effectiveness was again in favour of RFA. CONCLUSIONS: For very early HCC and in the presence of two or three nodules ⩽3cm, RFA is more cost-effective than resection; for single larger early stage HCCs, surgical resection remains the best strategy to adopt as a result of better survival rates at an acceptable increase in cost.

2013 - Focal nodular hyperplasia of the liver in children after hematopoietic stem cell transplantation [Articolo su rivista]
Masetti, Riccardo; Zama, Daniele; Gasperini, Pietro; Morello, William; Prete, Arcangelo; Colecchia, Antonio; Festi, Davide; Pession, Andrea
abstract

Background: Benign nodular hepatic regenerating lesions such as focal nodular hyperplasia (FNH) have been reported as rare complications of the antineoplastic therapy received during infancy. Little is known about the risk factors associated with the onset of these lesions and their diagnostic management. Methods: We have analyzed a series of benign hepatic nodular lesions occurring in children previously treated for malignant tumors in our institution in a period of 11 years. An extensive description of the imaging presentation of the lesions has been provided to facilitate the differential diagnosis, and a risk factor analysis has been conducted. Results: A total of 14 diagnoses (10 FNH and 4 hemangiomas) of benign nodular hepatic lesions have been found. Hematopoietic stem cell transplantation is the most important statistically independent risk factor associated with the development of these lesions, especially for FNH. No malignant transformation of nodules has been recorded during a median follow-up time of 4 years. Conclusions: In our experience, FNH is the most frequent benign nodular hepatic lesions occurring after treatment for childhood cancer. Hematopoietic stem cell transplantation is the most important risk factor to be taken in account. After a secure diagnosis of these benign lesions, only a close imaging follow-up is recommended.

2013 - Letter: FibroTest for staging fibrosis in non-alcoholic fatty liver disease - authors' reply [Articolo su rivista]
Festi, Davide; Schiumerini, Ramona; Scaioli, Eleonora; Colecchia, Antonio
abstract

No abstract available

2013 - Long-term leukocyte natural α-interferon and ribavirin treatment in hepatitis C virus recurrence after liver transplantation [Articolo su rivista]
Tamè, M; Buonfiglioli, F; DEL GAUDIO, Massimo; Lisotti, A; Cecinato, Paolo; Colecchia, Antonio; Azzaroli, Francesco; D'Errico, Antonietta; Arena, R; Calvanese, C; Quarneti, C; Ballardini, G; Pinna, ANTONIO DANIELE; Mazzella, Giuseppe
abstract

AIM: To evaluate the effect of long-term treatment with leukocyte natural α-interferon (ln-α-IFN) plus ribavirin (RBV). METHODS: Forty-six patients with hepatitis C virus (HCV) recurrence received 3 MU three times a week of ln-α-IFN plus RBV for 1 mo; then, patients with good tolerability (n = 30) were switched to daily IFN administration, while the remaining were treated with the same schedule. Patients have been treated for 12 mo after viral clearance while non-responders (NR) entered in the longterm treatment group. Liver biopsies were planned at baseline, 1 year after sustained virological response (SVR) and at 36 mo after start of therapy in NR. Med- Calc software package was used for statistical analysis. RESULTS: About 16.7% of genotype 1-4 and 70% of genotype 2-3 patients achieved SVR. Nine patients withdrew therapy because of non-tolerance or noncompliance. A significant improvement in serum biochemistry and histological activity was observed in all SVR patients and long-term treated; 100% of patients with SVR achieved a histological response (fibrosis stabilization or improvement) with a significant reduction in mean staging value (from 2.1 to 1.0; P = 0.0031); histological response was observed in 84% of long-term treated patients compared to 57% of drop-out. Six patients died during the entire study period (follow-up 40.6 ± 7.7 mo); of them, 5 presented with severe HCV recurrence on enrollment. Diabetes (OR = 0.38, 95%CI: 0.08-0.59, P = 0.01), leukopenia (OR = 0.54, 95%CI: 0.03-0.57, P = 0.03) and severe HCV recurrence (OR = 0.51, 95%CI: 0.25-0.69, P = 0.0003) were variables associated to survival. Long-term treatment was well tolerated; no patients developed rejection or autoimmune disease. CONCLUSION: Long-term treatment improves histology in SVR patients and slows disease progression also in NR, leading to a reduction in liver decompensation, graft failure and liver-related death.

2013 - Review article:the diagnosis of non-alcoholic fatty liver disease-availability and accuracy of non-invasive methods [Articolo su rivista]
Festi, Davide; Schiumerini, Ramona; Marzi, Luca; Di Biase, A. R.; Mandolesi, D.; Montrone, Lucia; Scaioli, Eleonora; Bonato, G.; Marchesini Reggiani, Giulio; Colecchia, Antonio
abstract

Background Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of clinical conditions, actually representing an emerging disease of great clinical interest. Currently, its diagnosis requires liver biopsy, an invasive procedure not free from potential complications. However, several non-invasive diagnostic strategies have been proposed as potential diagnostic alternatives, each with different sensitivities and accuracies. Aim To review non-invasive diagnostic parameters and tools for NAFLD diagnosis and to formulate a diagnostic and prognostic algorithm for a better classification of patients. Methods A literature search was carried out on MEDLINE, EMBASE, Web of Science and Scopus for articles and abstracts in English. The search terms used included 'NAFLD', 'non invasive method and NAFLD', 'transient elastography' and 'liver fibrosis'. The articles cited were selected based on their relevancy to the objective of the review. Results Ultrasonography still represents the first-line diagnostic tool for simple liver steatosis; its sensitivity could be enhanced by the complex biochemical score SteatoTest. Serum cytokeratin-18 is a promising and accurate non-invasive parameter (AUROCs: 0.83; 0.91) for the diagnosis of non-alcoholic steatohepatitis (NASH). The staging of liver fibrosis still represents the most important prognostic problem: the most accurate estimating methods are FibroMeter, FIB-4, NAFLD fibrosis score (AUROCs: 0.94; 0.86; 0.82) and transient elastography (AUROC: 0.84-1.00). Conclusions Different non-invasive parameters are available for the accurate diagnosis and prognostic stratification of non-alcoholic fatty liver disease which, if employed in a sequential algorithm, may lead to a reduced use of invasive methods, i.e. liver biopsy.

2012 - Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis [Articolo su rivista]
Colecchia, Antonio; Montrone, Lucia; Scaioli, Eleonora; Bacchi Reggiani, Maria Letizia; Colli, A; Casazza, G; Schiumerini, Ramona; Turco, Laura; Di Biase, Ar; Mazzella, Giuseppe; Marzi, Luca; Arena, U; Pinzani, M; Festi, Davide
abstract

BACKGROUND & AIMS: The hepatic vein pressure gradient (HVPG) is the standard used to determine the degree of portal hypertension (PH) and an important prognostic factor for patients with cirrhosis; HVPG values correlate with the presence of esophageal varices (EV). However, HVPG can only be accurately determined at specialized centers; noninvasive methods are needed to predict HVPG values and the presence of EV. We compared the diagnostic performance of spleen stiffness (SS) measurement by transient elastography with that of liver stiffness (LS) and of other recently proposed noninvasive tests. METHODS: We measured SS and LS in 100 consecutive patients with hepatitis C virusinduced cirrhosis. Patients were also assessed by FibroScan, HVPG, esophagogastroduodenoscopy, and liver biopsy. We also analyzed LSspleen diameter to platelet ratio score and platelet count to spleen diameter. RESULTS: SS and LS were more accurate than other noninvasive parameters in identifying patients with EV and different degrees of PH. A linear model that included SS and LS accurately predicted HVPG values (R 2 = 0.85). The results were internally validated using bootstrap analysis. CONCLUSIONS: Measurement of SS can be used for noninvasive assessment and monitoring of PH and to detect EV in patients with hepatitis C virusinduced cirrhosis

2012 - Non invasive parameters for predicting esophageal varices in children: their sequential use provides the best accuracy [Articolo su rivista]
Colecchia, Antonio; Festi, Davide; Di Biase, A. R.
abstract

No abstract available

2012 - Relationship between hepatic hemodynamics assessed by Doppler ultrasound and liver stiffness [Articolo su rivista]
Salvatore, V; Borghi, A; Peri, E; Colecchia, A; Li Bassi, S; Montrone, L; Di Donato, R; Conti, F; Crespi, C; Festi, D; Bernardi, M; Andreone, P; Bolondi, L.
abstract

AIM: We tested the relationship between hepatic haemodynamics assessed by Doppler ultrasonography and liver stiffness assessed by Transient Elastography in hepatitis C related chronic liver disease. METHODS: Three liver Doppler ultrasound parameters (hepatic artery resistance index, splenic artery resistance index and waveform pattern in hepatic veins) and liver stiffness measured by Transient Elastography were analysed in one hundred consecutive patients affected by hepatitis C related chronic liver disease. RESULTS: Hepatic and splenic arteries resistance indexes correlate significantly (p<0.0001 for both) with liver stiffness. A hepatic artery resistance index cut-off value of 0.64 provided sensitivity and specificity respectively of 84.4% and 69.1% for predicting liver stiffness ≤or >13 kPa, whereas a splenic artery resistance index cut-off value of 0.56 provided sensitivity and specificity respectively of 81.3% and 48.5%. The coincidental finding of both resistance indexes above the respective cut-off values showed a good accuracy in identifying patients with liver stiffness values >13 kPa (accuracy=78%, +LR=2.90, -LR=0.31). A significant difference in liver stiffness values was evident between patients with triphasic and bi- or monophasic waveform pattern (p=0.005). CONCLUSIONS: Hepatic and splenic arteries resistance indexes and the hepatic veins waveform pattern assessed by Doppler ultrasound may provide information similar to that of Transient Elastography in hepatitis C related chronic liver disease.

2012 - Reply [Articolo su rivista]
Colecchia, A.; Colli, A.; Festi, D.
abstract

2012 - Value of Transient Elastography Measured With Fibroscan in Predicting the Outcome of Hepatic Resection for Hepatocellular Carcinoma [Articolo su rivista]
Cescon, Matteo; Colecchia, Antonio; Cucchetti, Alessandro; Peri, Eugenia; Montrone, Lucia; Ercolani, Giorgio; Festi, Davide; Pinna, ANTONIO DANIELE
abstract

Objective: To evaluate the efficacy of preoperative liver stiffness (LS) measurement in predicting postoperative liver failure (PLF) after hepatectomy for hepatocellular carcinoma (HCC). Background: Hepatectomy for HCC in cirrhosis is affected by the risk of PLF, which is not completely predictable with common biochemical tests. Transient elastography with FibroScan is used to calculate the degree of LS, and it may be applicable to patients scheduled for hepatectomy to estimate perioperative complications. Methods: Ninety-two patients undergoing hepatectomy for HCC were prospectively evaluated with preoperative FibroScan. Accuracy of LS measurement in predicting PLF, the presence of cirrhosis, and the presence of clinical signs of portal hypertension (PH) were assessed using receiver operating characteristic (ROC) analysis. Results: In 2 patients, LS measurement could not be performed because of obesity; consequently, 90 patients were suitable for the study. Perioperative mortality was 2.2% (2 patients); PLF occurred in 28.9% of patients (26 patients). ROC analysis identified patients with LS value higher than or equal to 15.7 kPa as being at higher risk of PLF [area under the curve (AUC) = 0.865, 95% confidence interval: 0.776–0.928; sensitivity = 96.1%; specificity = 68.7%; positive predictive value = 55.6%; negative predictive value = 97.8%; positive likelihood ratio = 3.08; negative likelihood ratio = 0.056; P < 0.001]. Patients with LS value lower than 14.8 kPa had no PLF. LS value higher than 12.6 kPa and higher than 19.6 kPa was correlated with the presence of cirrhosis (AUC = 0.880; P < 0.001), and of PH (AUC = 0.786; P < 0.001), respectively. Multivariate analysis showed that low preoperative serum sodium levels (P = 0.012), histological cirrhosis (P = 0.024), and elevated LS (P = 0.005) were independent predictors of PLF. Conclusions: LS measured with FibroScan is a valid tool for prediction of PLF in patients undergoing hepatectomy for HCC.

2011 - Coeliac disease and autoimmune hepatitis: Gluten-free diet can influence liver disease outcome [Articolo su rivista]
Colecchia, Antonio; Di Biase, Ar; Scaioli, Eleonora; Festi, Davide
abstract

no abstract available

2011 - Focal nodular hyperplasia of the liver after intensive treatment for pediatric cancer: is hematopoietic stem cell transplantation a risk factor? [Articolo su rivista]
Masetti, Riccardo; Biagi, Carlotta; Kleinschmidt, Katharina; Prete, Arcangelo; Baronio, Federico; Colecchia, Antonio; Festi, Davide; Pession, Andrea
abstract

Focal nodular hyperplasia (FNH) is a benign hepatic lesion very rarely described in the pediatric population. It has been reported more frequently in patients treated for pediatric cancers with chemotherapy or hematopoietic stem cell transplantation. The use of high dosage of alkylating agents, the occurrence of venous occlusive disease, graft-versus-host disease, and other variables linked to the hematopoietic stem cell transplantation procedure can represent risk factors for the development of FNH in the pediatric age. The discovery of hepatic nodules in the follow-up of patients treated for malignancies suggests recurrence of disease and raises a diagnostic dilemma. Here we describe possible risk factors, clinical and radiological findings of eight pediatric patients who developed focal nodular hyperplasia after hematopoietic stem cell transplantation. The aim of this report is to provide useful diagnostic tools to facilitate accurate diagnosis of FNH and suggest a correct management of this benign lesion during postcancer follow-up. © 2011 Springer-Verlag.

2011 - Gut microbiota and its pathophysiology in disease paradigms [Articolo su rivista]
Festi, Davide; Schiumerini, Ramona; Birtolo, Chiara; Marzi, Luca; Montrone, Lucia; Scaioli, Eleonora; Di Biase, Ar; Colecchia, Antonio
abstract

The gut flora carries out important functions for human health, although most of them are still unknown, and an alteration of any of them, due to a condition of dysbiosis, can lead to relevant pathological implications. Commensal bacteria in the gut are essential for the preservation of the integrity of the mucosal barrier function and an alteration in the anatomic functional integrity of this barrier has been implicated in the pathophysiologic process of different diseases. The gut microflora plays a role in modulating the intestinal immune system; in fact, it is essential for the maturation of gut-associated lymphatic tissue, the secretion of IgA and the production of antimicrobial peptides. The enteric flora represents a potent bioreactor which controls several metabolic functions, even if most of them are still unknown. The main metabolic functions are represented by the fermentation of indigestible food substances into simple sugars, absorbable nutrients, and short-chain fatty acids. Furthermore, the gut microbiota exerts important trophic and developmental functions on the intestinal mucosa. This overview focuses briefly on the physiological role of the gut microbiota in maintaining a healthy state and the potential role played by disturbances of both the function and composition of the gut microbiota in determining important pathological conditions, such as irritable bowel syndrome, inflammatory bowel disease, metabolic syndrome, obesity, and cancer

2011 - Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure. [Articolo su rivista]
Colecchia, A; Di Biase, Ar; Scaioli, E; Predieri, Barbara; Iughetti, Lorenzo; Reggiani, Ml; Montrone, L; Ceccarelli, Pl; Vestito, A; Viola, L; Paolucci, Paolo; Festi, D.
abstract

BACKGROUND: After a Kasai procedure, 70% of patients with biliary atresia develop chronic liver disease with portal hypertension and oesophageal varices. AIMS: To investigate the role of new non-invasive parameters in predicting the presence of varices in patients with biliary atresia after a Kasai procedure and to identify the cut-off values of these parameters in predicting the presence of varices. METHODS: 31 patients with biliary atresia who had undergone a Kasai portoenterostomy were studied. Clinical, biochemical and abdominal ultrasound examination, liver stiffness measurement (LSM), LSM-spleen diameter to platelet ratio score (LSPS) and upper digestive endoscopy were performed. RESULTS: 15 (47%) patients had oesophageal varices (Group A) and 16 had no varices (Group B). Median values of LSM (kPa) and LSPS were significantly higher in Group A than in Group B (LSM: 17.0 vs. 7.5, respectively; p=0.0001; LSPS: 19.62 vs. 2.94, respectively; p=0.0001). The optimal cut-offs for predicting oesophageal varices were: LSM>10.6 kPa (sensitivity: 87%, specificity: 87.5%, PPV: 87%, NPV: 87.5%, and AUC: 0.92) and LSPS ≥9.2 (sensitivity: 91%, specificity: 92%, PPV: 91%, NPV: 92%, and AUC: 0.96). CONCLUSIONS: Non-invasive methods can predict the presence of oesophageal varices in patients with biliary atresia; the sequential use of two non-invasive methods improves accuracy.

2011 - Percutaneous liver biopsy in the clinical management of hepatocellular carcinoma:back to the future [Articolo su rivista]
Colecchia, Antonio; Montrone, Lucia; Scaioli, Eleonora; Festi, Davide
abstract

no abstract available

2011 - Plasma antioxidant enzymes and clastogenic factors as possible biomarkers of colorectal cancer risk [Articolo su rivista]
Maffei, F; Angeloni, C; Malaguti, M; Moraga, Jm; Pasqui, F; Poli, C; Colecchia, A; Festi D, ; Hrelia, P; Hrelia, S.
abstract

2011 - Pre-operative liver biopsy in cirrhotic patients with early hepatocellular carcinoma represents a safe and accurate diagnostic tool for tumour grading assessment [Articolo su rivista]
Colecchia, A; Scaioli, E; Montrone, L; Vestito, A; Di Biase, Ar; Pieri, M; D'Errico-Grigioni, A; Bacchi-Reggiani, Ml; Ravaioli, M; Grazi, Gl; Festi,
abstract

BACKGROUND & AIMS: Knowledge of pre-operative tumour grade is crucial in the management of hepatocellular carcinoma (HCC) because it can influence recurrence and survival after surgery. The accuracy of pre-operative needle core biopsy (NCB) in tumour grading has been assessed in only a few studies with conflicting results. Our aim was to determine the long-term safety and the overall accuracy of NCB in assessing tumour grading in subjects who had undergone liver resection for a single HCC. METHODS: Eighty-one cirrhotic patients with HCC who had undergone NCB before liver resection were selected. Only patients with a single HCC and with at least a five-year-follow-up were included. Tumour grading was scored according to a modified Edmondson-Steiner classification: well/moderately (low grade) vs poorly-differentiated (high grade). RESULTS: In the 81 patients with a solitary HCC (mean size 4.1 ± 2.3cm) tumour grade was correctly identified by NCB in 74 out of 81 (91.4%) HCCs. NCB overall sensitivity and specificity were 65% and 98.1%, respectively, with a PPV of 92% and an NPV of 91%. No major complications (in particular tumour seeding) were observed. The overall survival rates at 1, 3, and 5 years were 83%, 62%, and 44%, respectively; the recurrence rate after a 5-year-follow-up was 56.2% for low grade and 82.3% for high grade tumours (p<0.007). CONCLUSIONS: Pre-operative NCB can be performed on early (<5 cm) HCC cirrhotic patients because it provides histologically useful information for HCC management with good accuracy and a low complication rate.

2010 - Autoimmune liver diseases in a paediatric population with coeliac disease. A 10-year single-centre experience [Articolo su rivista]
Di Biase, A. R.; Colecchia, Antonio; Scaioli, E.; Berri, R.; ViolaL, ; Vestito, Amanda; Balli, F.; Festi, Davide
abstract

2010 - Calcolosi della colecisti [Capitolo/Saggio]
Festi, D.; Colecchia, A.; Scaioli, E.; Vestito, A.
abstract

Fisiopatologia della litiasi biliare

2010 - Calcolosi della colecisti complicata [Capitolo/Saggio]
Festi, D.; Colecchia, A.; Scaioli, E.; Vestito, A.
abstract

Fisiopatologia e quadri clinici delle complicanze della litiasi biliare

2010 - Calcolosi della via biliare principale [Capitolo/Saggio]
Festi, D.; Colecchia, A.; Scaioli, E.; Vestito, A.
abstract

Fisiopatologia, quadri clinici e trattamento della calcolosi della via biliare principale

2010 - Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation [Articolo su rivista]
Piscaglia, Fabio; Gianstefani, Alice; Ravaioli, Matteo; Golfieri, Rita; Cappelli, A.; Giampalma, E.; Sagrini, Elisabetta; Imbriaco, Grazia; Pinna, ANTONIO DANIELE; Bolondi, Luigi; Andreone, Pietro; Bianchi, Giampaolo; Biselli, Maurizio; Cescon, Matteo; Colecchia, Antonio; Cucchetti, Alessandro; DEL GAUDIO, Massimo; Ercolani, Giorgio; Grazi, GIAN LUCA; Lenzi, Marco; Leoni, S.; Mazzella, Giuseppe; Morelli, M. C.; Tame', Mariarosa; Verucchi, Gabriella; Vivarelli, Marco
abstract

Malignant portal vein thrombosis is a contraindication for liver transplantation. Patients with cirrhosis and early hepatocellular carcinoma (HCC) may have either malignant or benign (fibrin clot) portal vein thrombosis. The aim of this study was to assess prospectively whether well-defined diagnostic criteria would enable the nature of portal vein thrombosis to be established in patients with HCC under consideration for liver transplantation. Benign portal vein thrombosis was diagnosed by the application of the following criteria: lack of vascularization of the thrombus on contrast-enhanced ultrasound and on computed tomography or magnetic resonance imaging, absence of mass-forming features of the thrombus, absence of disruption of the walls of veins, and, if uncertainty persisted, biopsy of the thrombus for histological examination. Patients who did not fulfill the criteria for benign thrombosis were not placed on the transplantation list. In this study, all patients evaluated at our center during 2001-2007 with a diagnosis of HCC in whom portal vein thrombosis was concurrently or subsequently diagnosed were discussed by a multidisciplinary group to determine their suitability for liver transplantation. The outcomes for 33 patients who met the entry criteria of the study were as follows: in 14 patients who were placed on the transplantation list and underwent liver transplantation, no malignant thrombosis was detected when liver explants were examined histologically; 5 patients who were placed on the transplantation list either remained on the list or died from causes unrelated to HCC; in 9 patients, liver transplantation was contraindicated on account of a strong suspicion, or confirmation, of the presence of malignant portal vein thrombosis; and 5 patients who were initially placed on the transplantation list were subsequently removed from it on account of progression of HCC in the absence of evidence of neoplastic involvement of thrombosis. In conclusion, for a patient with HCC and portal vein thrombosis, appropriate investigations can establish whether the thrombosis is benign; patients with HCC and benign portal vein thrombosis are candidates for liver transplantation.

2010 - Fish oil based emulsion for the treatment of parenteral nutrition associated liver disease in adult patient [Articolo su rivista]
Pironi, L; Colecchia, A; Guidetti, M; Belluzzi, A; D’Errico, A
abstract

2010 - Fish oil-based emulsion for the treatment of parenteral nutrition associated liver disease in an adult patient [Articolo su rivista]
Pironi, L.; Colecchia, A.; Guidetti, M.; Belluzzi, A.; D'Errico, A.
abstract

Background & aims: Reversal of parenteral nutrition associated liver disease with fish oil emulsion (FO) has been reported in infants. We report a similar case in an adult patient. Methods: A 58 year-old female on home parenteral nutrition for a short bowel syndrome due to Crohn's disease, showed a progressive worsening of liver steatosis, and a persistent increase of the plasma liver function tests (LFTs). LFTs, serum alpha-tochopherol, red blood cell membrane fatty acids and liver histology were evaluated before and after an 8 month treatment with FO. Results: The patient's LFT's improved. There was an increase of the n-3 and a decrease of the n-6 series of fatty acids in erythrocyte membrane. There was an approximate 30% increase in vitamin E status. Before FO, liver histology showed a non-alcoholic steatohepatitis with grade 2 steatosis and inflammation and stage 3 fibrosis. After the treatment, steatosis and inflammation were grade 1, whereas fibrosis remained at stage 3. Conclusions: Infusion of FO was associated with consistent changes of cell membrane fatty acid structure and with mild improvement of vitamin E status. A potential role of FO in decreasing liver steatosis and inflammation with no change of liver fibrosis might be suggested. © 2010 European Society for Clinical Nutrition and Metabolism.

2010 - Growth and nutritional evaluation in children with chronic liver disease (CLD) before and after liver transplantation [Abstract in Rivista]
Predieri, Barbara; Di Biase, A. R.; Berri, R.; Bruzzi, Patrizia; Colecchia, A.; Iughetti, Lorenzo
abstract

Acute or final hepatic insufficiency needs to be treated with hepatic transplantation. It represents an important cause of growth retardation mainly due to decrease of daily caloric intake and macro-/micronutrient adsorption and alteration of hepatic metabolism. Sometimes nutritional supplementation may be necessary. Aim of this study is to evaluate growth and nutritional status in children with hepatic insufficiency before and after hepatic transplantation.Ten children (4 boys and 6 girls; 3-13 years; 8 biliary atresy, 1 type I tyrosinemia, 1 Alagille’s Syndrome) were included in the study. Height, weight, and laboratory (albumin, hepatic and biliary index, lipids profile, coagulation) data were detected before, after 1, and 3 year hepatic transplantation. Insulin-like growth factor 1 (IGF-1), IGF-binding protein 3 (IGF-BP3), vitamin B12, and folic acid were measured only at the last visit. Parametric statistical analysis was performed. The auxological and laboratory characteristics of the patients are reported in the Table (p<0.05; *1 year vs. before; **3 years vs. both before and 1 year). Basal growth parameters were slightly compromised. Weight and BMI z-score significantly increased already 1 year after hepatic transplantation, resulting within normal range also at 3 years, while height z-score was significantly improved only after 3 years. Albumin levels resulted slightly impair before transplantation and significantly increase at the last control. A significant progressive decreased of bilirubin, biliary acid, alkaline phosphatase, and transaminase values was found after 1 and 3 years, finally resulting in the normal range. No other significant change was demonstrated for laboratory data. At the last evaluation nutritional and growth index (IGF-1 and IGF-BP3) were within normal range for age and sex. Our results confirm that a correct diet, sometimes supported by enteral nutrition, make it possible to obtain a satisfactory nutritional status before hepatic transplantation. This approach allows a more rapid improvement of growth already 1 year after surgery. IGF-1 levels may be considered an useful tool to evaluate clinical and nutritional status of these patients.

2010 - Liver stiffness, a non-invasive marker of liver disease: a core study group report [Articolo su rivista]
Bonino, F; Arena, U; Brunetto, Mr; Coco, B; Fraquelli, M; Oliveri, F; Pinzani, M; Prati, D; Rigamonti, C; Vizzuti, F; Liver Stiffness Study Group 'Elastica' of the Italian Association for the Study of the Liver., Collaborators: Balocco M; Forni, G; Bottelli, R; Bruno, R; Filice, C; Bruno, S; Cammà, C; Craxì, A; Colletta, C; Colombatto, P; Colombo, M; Fatuzzo, F; Larocca, L; Montineri, A; Festi, D; Colecchia, A; Grasso, A; Maida, I; Mazzotta, F; Marino, N; Blanc, P; Puoti, M; Quartini, M; Sacchini, D; Vinelli, F.
abstract

2010 - Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. [Articolo su rivista]
Festi, D; Reggiani, Ml; Attili, Af; Loria, Paola; Pazzi, P; Scaioli, E; Capodicasa, S; Romano, F; Roda, E; Colecchia, A.
abstract

BACKGROUND AND AIMS: The knowledge of natural history is essential for disease management. We evaluated the natural history (e.g. frequency and characteristics of symptoms and clinical outcome) of gallstones (GS) in a population-based cohortstudy. METHODS: A total of 11 229 subjects (6610 men, 4619 women, age-range: 29-69 years, mean age: 48 years) were studied. At ultrasonography, GS were present in 856 subjects (338 men, 455 women) (7.1%). GS were followed by means ofa questionnaire inquiring about the characteristics of specific biliary symptoms. RESULTS: At enrollment, 580 (73.1%) patients were asymptomatic, 94 (11.8%) had mild symptoms and 119 (15.1%) had severe symptoms. GS patients were followed upfor a mean period of 8.7 years; 63 subjects (7.3%) were lost to follow up. At the end of the follow up, of the asymptomatic subjects, 453 (78.1%) remained asymptomatic; 61 (10.5%) developed mild symptoms and 66 (11.4%) developed severe symptoms. In subjects with mild symptoms, the symptoms disappeared in 55 (58.5%), became severe in 23 (24.5%), remained stable in 16 (17%); in subjects with severesymptoms, the symptoms disappeared in 62 (52.1%), became mild in 20 (16.8%) and remained stable in 37 (31.1%). A total of 189 cholecystectomies were performed: 41.3% on asymptomatic patients, 17.4% on patients with mild symptoms and 41.3% onpatients with severe symptoms. CONCLUSIONS: This study indicates that: (i) asymptomatic and symptomatic GS patients have a benign natural history; (ii) the majority of GS patients with severe or mild symptoms will no longer experience biliary pain; and (iii) a significant proportion of cholecystectomies areperformed in asymptomatic patients. Expectant management still represents a valid therapeutic approach in the majority of patients.

2009 - A RETROSPECTIVE STUDY ON INTRAHEPATIC CHOLESTASIS OF PREGNANCY: MARKERS OF PREMATURE DELIVERY [Abstract in Atti di Convegno]
Alessandrelli, F.; Azzaroli, F.; Feletti, V.; Lisotti, A.; Buonfiglioli, F.; Montagnani, M.; Colecchia, A.; Festi, D.; Lodato, F.; Roda, E.; Mazzella, G.
abstract

Background: Intrahepatic Cholestasis of Pregnancy (ICP) carries with it a higher frequency of premature delivery (20 to 60%), a marker ofperinatal morbility/mortality. Therefore, it is important to identify markers of premature delivery. Aim: To retrospectively evaluate, in a large case study, the presence of markers predictive of premature delivery. Materials and Methods: Clinical records of all patients diagnosed with ICP in Policlinic S.Orsola-Malpighi (Bologna, Italy) from January 2001 until December 2007 have been collected. For all patients the following informations were available: subjective pruritus evaluation, standard biochemical parameters, serum bile acids (BA) determination, abdomen ultrasonography and APGAR index. From diagnosis until a week after delivery, biochemistry and fetal health have been controlled weekly. Student’s t Test, Mann-Whitney, Pearson’s correlation test and a stepwiselogistic regression analysis were performed as appropriate. Results: 169 clinical records have been gathered. Patients with premature delivery, compared to those who delivered closer to term, presented a significantly earlier appearance of pruritus (r = 0.4858) and higher levels of chenodeoxycholic acid (r = −0.2835). No significant differences were observed for APGAR index and rate of fetal complications according to treatment and time of delivery. Two fetal deaths occurred (fetal infection by Parvovirus B19 and haemolysis for ABO incompatibility) before week 34 with serum BA below 20 mM/l. According to the multivariate analysis, the only variable associated with preterm delivery is the early onset of cholestasis, that exposes to a risk twice than normal (OR = 2.044; 95% CI 1.40−2.98; p = 0.0002). Conclusions: The strongest predictor of premature delivery in our population is the time of onset of pruritus with an OR of 2.044.

2009 - Bacteria flora,gas and antibiotics [Articolo su rivista]
Colecchia, Antonio; Festi, Davide; Scaioli, Eleonora; V., Ruggiero; M., Berardino; P., Portincasa
abstract

2009 - Body weight,lifestyle,dietary habits and gastroesophageal reflux disease [Articolo su rivista]
Festi, Davide; Scaioli, Eleonora; Baldi, Fabio; Vestito, Amanda; Pasqui, Francesca; A. R., Di Biase; Colecchia, Antonio
abstract

2009 - C-11 Acetate does not enhance usefulness of F-18 FDG PET/CT in differentiating between focal nodular hyperplasia and hepatic adenoma [Articolo su rivista]
Magini, Giulia; Farsad, M; Frigerio, Marta; Serra, C; Colecchia, Antonio; Jovine, E; Vivarelli, Marco; Feletti, Valentina; Golfieri, R; Patti, C; Fanti, Stefano; Franchi, Roberto; Lodi, F; Boschi, S; Bernardi, Mauro; Trevisani, Franco
abstract

2009 - Development and application of a simple ad powerful toolfor nutrition and lifestyle education for the italian general population by general practitioners and family paediatricians [Articolo su rivista]
Festi, D; Colecchia, A; Pini, S; E, Scaioli; Maffeis, C; Coccheri, S; Petroni, Ml
abstract

2009 - Development and application of a simple and powerful tool for nutrition and lifestyle education for the Italian general population by general practitioners and family paediatricians [Articolo su rivista]
Festi, Davide; Colecchia, Antonio; Pini, S.; Scaioli, E.; Maffeis, C.; Coccheri, S.; Petroni, M. L.
abstract

2009 - H 2breath testing for other gas-related syndromes [Articolo su rivista]
Vernia, P.; Barbara, G.; Benini, L.; Colecchia, A.; Distefano, M.; Festi, D.; Nardone, G.
abstract

Non disponibile

2009 - H2 breath testing for the other gas related syndromes [Articolo su rivista]
Vernia, P; Barbara, G; Benini, L; Colecchia, A; Di Stefano, M; Festi, D; Nardone, G
abstract

2009 - H2 breath tests: methodological audits in adults and children [Articolo su rivista]
Di Stefano, M; Certo, M; Colecchia, A; Sorge, M; Perri, F
abstract

2009 - HIGH FREE AND GLYCOCONJUGATED AND LOW TAUROCONJUGATED BA LEVELS IN SERUM ARE THE MIRROR OF INTESTINAL EVENTS AND HEPATIC UPTAKE [Abstract in Atti di Convegno]
Buonfiglioli, F; Azzaroli, F; Montagnani, M; Simoni, P; Locatelli, M; Raspanti, Me; Lisotti, A; Lodato, F; Alessandrelli, F; Colecchia, A; Festi, D; Roda, A; Roda, E; Mazzella, G
abstract

Fasting serum bile acid (BA) composition in healthy people is still unknown: only recently an adequate technology to measure in the same sample both free and conjugated BAs has been developed. Aim of this study was to evaluate serum BA levels and composition in healthy subjects. Methods: 30 healthy young subjects (15 females and 15 males) [no gallstone disease, no abnormal liver tests, no liver steatosis on ultrasonography; mean age 26.5±0.8 (range 22−40 yrs)] were selected. A blood sample was taken in the morning after a standardized overnight fasting period (8 hours). Serum samples, diluted 1:6 (v/v) with NaOH 0.1N and heated to 64ºC for 30 minute, were loaded on conditioned cartridge and washed with 10 ml of water. The cartridge was eluted with 5 ml of methyl alcohol; the eluate was dried under vacuum and then reconstituted with the mobile phase (70:30 v/v ammonium acetate buffer/acetonitrile) and injected into HPLC-ESI-MS instrument. The recovery of each BA ranged from 80% to 96% and accordingly corrected. Results: Total serum BA levels were 3.65±0.40 mmol/L (male:4.2±0.7; female:3.1±0.4 mmol/L, p = ns); total cholate levels were 0.65±0.11 mmol/L (M:0.79±0.18; F: 0.52±0.13 mmol/L, p = ns); total chenodeoxycholate levels were 1.7±0.2 mmol/L (M: 2.0±0.32; F: 1.4±0.24 mmol/L, p = ns); total deoxycholate levels were 0.8±0.13 mmol/L (M: 0.9±0.24; F: 0.72±0.10 mmol/L, p = ns); total lithocholate levels were below the detectability threshold; total ursodeoxycholate levels were 0.51±0.03 mmol/L (M: 0.55±0.051; F: 0.50±0.05 mmol/L, p = ns). Free BA levels were 1.9±0.3 mmol/L (male: 2.4±0.5; female: 1.4±0.19 mmol/L, p = ns); total glycoconjugate levels were 1.5±0.14 mmol/L (M: 1.7±0.18; F: 1.32±0.22 mmol/L, p = ns); total tauroconjugate levels were 0.29±0.05 mmol/L (M: 0.17±0.03; F: 0.41±0.09 mmol/L, p = 0.02). Conclusions: Free and glycoconjugated BAs undergo passive diffusion and facilitated transport along the entire small intestine, accounting for their higher fractional serum level. Tauroconjugated BAs absorption occurs only in the distal ileum through an active transport system, and their hepatic uptake is extremely efficient, accounting for their lower spill into the systemic circulation; their higher levels in females suggest a pivotal role of oestrogens in the modulation of the transport systems involved in Bas enterohepatic circulation.

2009 - Mesalazine and rifaximin in symptomatic uncomplicated diverticular disease [Abstract in Rivista]
Festi, Davide; Colecchia, Antonio
abstract

2009 - Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference [Articolo su rivista]
Gasbarrini, A; Corazza, Gr; Gasbarrini, G; Montalto, M; Di Stefano, M; Basilisco, G; Parodi, A; Usai-Satta, P; Vernia, P; Anania, C; Astegiano, M; Barbara, G; Benini, L; Bonazzi, P; Capurso, G; Certo, M; Colecchia, A; Cuoco, L; Di Sario, A; Festi, D; Lauritano, C; Miceli, E; Nardone, G; Perri, F; Portincasa, P; Risicato, R; Sorge, M; Tursi, A; 1st Rome H2-Breath Testing Consensus Conference Working, Group
abstract

2009 - Natural history of small gallbladder polyps is benign: evidence from a clinical and pathogenetic study [Articolo su rivista]
Colecchia, A; Larocca, A; Scaioli, E; Bacchi-Reggiani, Ml; Di Biase, Ar; Azzaroli, F; Gualandi, R; Simoni, P; Vestito, A; Festi, D
abstract

2009 - UDCA UP-REGULATES HUMAN PLACENTAL BCRP EXPRESSION: PRELIMINARY RESULTS [Relazione in Atti di Convegno]
Azzaroli, F.; Raspanti, M. E.; Alessandrelli, F.; Feletti, V.; Buonfiglioli, F.; Cecinato, P.; Montagnani, M.; Colecchia, A.; Festi, D.; Roda, E.; Mazzella, G.
abstract

In Intrahepatic Cholestasis of Pregnancy (ICP) an accumulation of bile acids (BA) in the fetal compartment occurs. It is known that a BA efflux is induced by UDCA administration but the molecular basis of this transplacental transport is only partially defined. Aim of the present study was to determine if placental BCRP, able to transport BA, is regulated by UDCA in ICP. Methods: 14 pregnant women with ICP (6 untreated, 37.5±1.33 years; 8 treated with UDCA − 25 mg/kg/day, 32.14±2.16 years) and 7 agematched healthy controls (34.2±1.2 years) have agreed to participate to the study (none had gallstone disease, abnormal liver tests, liver steatosis on ultrasonography). Placentas were obtained at delivery and processed for membrane extraction. Protein expression was evaluated by standard immunoblotting techniques using actin as an internal control. Statistical differences between groups were evaluated by one way ANOVA with Dunn’s Multiple Comparison test. Results: BCRP was expressed only on the apical membrane of the syncytiotrophoblast. A significant difference was observed between the three groups (ANOVA, p = 0.01). BCRP expression was similar in cont rols and in the untreated ICP group. The administration of UDCA induced a significant increase in placental BCRP expression compared to controls (254.5±58.46 vs 100±8.002% of control, p<0.05). Conclusion: In this preliminary study we are able to confirm that BCRP is expressed only on the apical membrane of the syncytiotrophoblast. ICP treatment with high dose UDCA significantly up-regulates placental BCRP expression favouring BA transport towards the foetal compartment.

2008 - Clinical trial: peg-interferon alfa-2b and ribavirin for the treatment of genotype-1 hepatitis C recurrence after liver transplantation [Articolo su rivista]
Lodato, F; Berardi, S; Gramenzi, A; Mazzella, G; Lenzi, M; Morelli, Mc; Tame, Mr; Piscaglia, F; Andreone, P; Bologna Liver Transplantation Group (BLTG), [. . .; Ballardini, G; Bernardi, M; Bianchi, Fb; Biselli, M; Bolondi, L; Cescon, M; Colecchia, A; D'Errico, A; Del Gaudio, M; Ercolani, G; Grazi, Gl; Grigioni, W; Lorenzini, S; Pinna, Ad; Ravaioli, M; Roda, E; Sama, C; Vivarelli, M.; ], . .
abstract

Background Treatment of hepatitis C virus (HCV) recurrence after liver transplantation (LT) is difficult with low response rates. Aim To assess the safety and efficacy of pegylated-interferon (PEG-IFN) alfa-2b + ribavirin (RBV) in patients with post-LT recurrent genotype-1 HCV and to establish stopping rules according to response. Methods Fifty-three patients with post-LT HCV recurrence were enrolled. Patients received PEG-IFN alfa-2b 1.0 μ/kg/week plus RBV 8–10 mg/kg/day for 24 weeks. Those with ‘early virological response at week 24’ (EVR24) continued treatment for 24 weeks (group A). Patients without EVR24 were randomized to continue (group B) or to discontinue (group C). Results Overall sustained virological response (SVR) was 26% (14/53). Alanine aminotransferase, rapid virological response, EVR12, EVR24, undetectable serum HCV-RNA at weeks 12 (cEVR12) and 24 (cEVR24) were related to SVR. cEVR12 and cEVR24 (OR: 14.7; 95% CI: 2.02–106.4) were independent predictors of SVR. All patients with SVR, had cEVR12. No patient in groups B and C achieved end-of-treatment response. One patient in group B had SVR. Conclusions Pegylated-interferon alfa-2b was effective in one of four of patients with HCV genotype 1 after LT. Treatment should be discontinued in patients with no virological response at week 12. Further studies are needed to evaluate whether a longer treatment period may be beneficial in patients with ≥2 log10 drop in HCV-RNA at week 24

2008 - Effect of combined IFN-Alpha/Ribavirin Treatment in HCV disease-related progression [Capitolo/Saggio]
Festi, Davide; Lodato, Francesca; Mazzella, Giuseppe; Colecchia, Antonio
abstract

Chronic HCV hepatitis is a progressive disease; if not treated it progress towards liver cirrhosis, hepatocellular carcinoma and/or liver insufficiency. Different antiviral treatments are now available, whose success rate ranging from 20 to 65% of the patients, depending on factors related to the virus (viral load, genotype, etc) or to the host (gender, age, time of infections, precence of comorbidities).

2008 - Incidence of gallstone disease in Italy: Results from a multicenter, population-based Italian study (the MICOL project) [Articolo su rivista]
Festi, D; Dormi, A; Capodicasa, S; Staniscia, T; Attili, Af; Loria, Paola; Pazzi, P; Mazzella, G; Sama, C; Roda, E; Colecchia, A.
abstract

AIM: To evaluate gallstone incidence and risk factors in a large population-based study. METHODS: Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively, in 9611 of 11 109 (86.5%) subjects who were gallstone-free at the cross-sectional study. RESULTS: Six centers throughout Italy enrolled 9611 subjects (5477 males, 4134 females, aged 30-79 years), 9517 of whom were included into analysis: 424 subjects (4.4%) had gallstones and 61 (0.6%) had been cholecystectomized yielding a cumulative incidence of 0.67% per year (0.66% in males, 0.81% in females). Increasing age, a high body mass index (BMI), a history of diabetes, peptic ulcer and angina, and low cholesterol and high triglyceride levels were identified as risk factors in men while, in females, the only risk factors were increasing age and a high BMI. Increasing age and pain in the right hypocondrium in men and increasing age in females were identified as predictors of gallstones. Pain in the epigastrium/right hypocondrium was the only symptom related to gallstones; furthermore, some characteristics of pain (forcing to rest, not relieved by bowel movements) were significantly associated with gallstones. No correlation was found between gallstone characteristics and clinical manifestations, while increasing age in men and increasing age and BMI in females were predictors of pain. CONCLUSION: Increasing age and BMI represent true risk factors for gallstone disease (GD); pain in the right hypocondrium and/or epigastrium is confirmed as the only symptom related to gallstones.

2008 - Transjugular intrahepatic portosystemic shunt: A case report of rescue management of unrestrainable variceal bleeding in a pregnant woman [Articolo su rivista]
Lodato, F.; Cappelli, A.; Montagnani, M.; Colecchia, A.; Festi, D.; Azzaroli, F.; Compagnone, G.; Cecinato, P.; Golfieri, R.; Mazzella, G.
abstract

Liver cirrhosis complications in pregnant women are frequent and death rate secondary to variceal bleeding is relevant. Both sclerotherapy and banding ligation seem to be safe procedures in pregnancy; when bleeding is not arrested endoscopically an emergency transjugular intrahepatic portosystemic shunt should be considered, but data regarding pregnant cirrhotic women are scarce. We describe the case of a pregnant woman at 14 weeks of gestation who underwent management of acute variceal bleeding by transjugular intrahepatic portosystemic shunt. Transjugular intrahepatic portosystemic shunt may represent a rescue treatment for failed attempts of band ligation or sclerotherapy. © 2007 Editrice Gastroenterologica Italiana S.r.l.

2008 - ransjugular intrahepatic portosystemic shunt: a case report of rescue management of unrestrainable variceal bleeding in a pregnant woman [Articolo su rivista]
Lodato, F; Cappelli, A; Montagnani, M; Colecchia, A; Festi, D; Azzaroli, F; Compagnone, G; Cecinato, P; Golfieri, R; Mazzella, G
abstract

2007 - Biliary symptoms, gallbladder motility, and cholecystectomy [Articolo su rivista]
Colecchia, Antonio; Festi, Davide
abstract

2007 - Clinical efficacy and effectiveness of ursodeoxycholic acid in cholestatic liver diseases [Articolo su rivista]
Festi, Davide; Montagnani, Marco; Azzaroli, Francesco; Lodato, Francesca; Mazzella, Giuseppe; Roda, Aldo; Di Biase, Ar; Roda, Enrico; Simoni, Patrizia; Colecchia, Antonio
abstract

Ursodeoxycholic acid (UDCA), previously used for cholesterol gallstone dissolution, is currently considered the first choice therapy for many forms of cholestatic syndromes. Many mechanisms and sites of action have been proposed for UDCA, but definitive data are still missing regarding the key points of its efficacy and optimal dosage in order to achieve a sustained clinical effect. Among the suggested mechanisms of action of UDCA, changes in bile acid pool composition, hepatocyte membrane protection, immunomodulatory effects and bicarbonate-rich hypercholeresis have been extensively studied. However, recent evidence indicate that UDCA is a potent intracellular signalling agent that counterbalances impaired biliary secretion, inhibits hepatocyte apoptosis and protects injured cholangiocytes against toxic effects of bile acids. It is clear that the relative contribution of these mechanisms to the anticholestatic action of UDCA depends on the type and stage of the liver injury. Available clinical evidence suggest that UDCA treatment has to be initiated as early as possible and that higher doses could be more efficacious in inducing and maintaining clinical remission of cholestatic diseases. The future availability of UDCA derivatives will possibly enhance the chances to effectively treat chronic cholestatic diseases.

2007 - Clinical trial: modulation of human placental multidrug resistance proteins in cholestasis of pregnancy by ursodeoxycholic acid [Articolo su rivista]
Azzaroli, Francesco; Mennone, A.; Feletti, Valentina; Simoni, Patrizia; Baglivo, E.; Montagnani, Marco; Rizzo, Nicola; Pelusi, Giuseppe; DE ALOYSIO, Domenico; Lodato, Francesca; Festi, Davide; Colecchia, Antonio; Roda, Enrico; Boyer, J. L.; Mazzella, Giuseppe
abstract

2007 - Colecistosi e tumori della colecisti [Capitolo/Saggio]
Colecchia, A.; Vestito, A.; Nikiforaki, A.; Festi, D.
abstract

Principali quadri ecografici della patologia colecistica

2007 - Ecosistema intestinale: aspetti fisiopatologici e terapeutici [Capitolo/Saggio]
Festi, D.; Vestito, A.; Nakiforaky, A.; Pasqui, F.; Colecchia, A.
abstract

L'ecosistema intestinale costituisce uno degli ecosistemi più complessi dell'uomo sia per l'elevata concentrazione microbica si a per la complessità della sua composizione. Le specie batteriche più rappresentative del colon sono quelle appartenenti ai generi Bacteroides, Bifidobacterium, Eubacterium. La microflora intestinale svolge numerose funzioni quali quelle metaboliche, trofiche e protetive.I microrganismi più comunemente usati come agenti terapeutici in quanto capaci di esercitare un'azione esclusivamente protettiva , sono i lattobacilli acido produttori, i bifidobatteri e lo streptococco. La dimostrazione che le cellule immunitarie ed epiteliali possono distinguere tra le diverse specie microbiche ha esteso i meccanismi d'azione dei probiotici oltre il semplice effetto barriera e antimicrobico.

2007 - Effects of UDCA on the foetus-maternal circulation of bilirubin in cholestasis of pregnancy [Relazione in Atti di Convegno]
Azzaroli, F.; Baglivo, E.; Feletti, V.; Locatelli, M.; Rizzo, N.; DE ALOYSIO, D.; Pelusi, G.; Montagnani, M.; Lodato, F.; Festi, D.; Colecchia, A.; Roda, A.; Roda, E.; Mazzella, G.
abstract

2007 - Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease [Articolo su rivista]
Colecchia, A; Vestito, A; Pasqui, F; Mazzella, G; Roda, E; Pistoia, F; Brandimarte, G; Festi, D
abstract

Aim: To comparatively ate the long term efficacy of Rifaximin and dietary fibers in reducing symptoms and/or complication frequency in symptomatic, uncomplicated diverticular disease. Methods: 307 patients (118 males, 189 females, age range: 40-80 years) were enrolled in the study and randomly assigned to: Rifaximin (400 mg bid for 7 d every month) plus dietary fiber supplementation (at least 20 gr/d) or dietary fiber supplementation alone. The study duration was 24 mo; both clinical examination and symptoms' questionnaire were performed every two months. Results: Both treatments reduced symptom frequency, but Rifaximin at a greater extent, when compared to basal values. Symptomatic score declined during both treatments, but a greater reduction was evident in the Rifaximin group (6.4 Â± 2.8 and 6.2 Â± 2.6 at enrollment, P = NS, 1.0 Â± 0.7 and 2.4 Â± 1.7 after 24 mo, P < 0.001, respectively). Probability of symptom reduction was higher and complication frequency lower (Kaplan-Meyer method) in the Rifaximin group (P < 0.0001 and 0.028, respectively). Conclusion: In patients with symptomatic, uncomplicated diverticular disease, cyclic administration of Rifaximin plus dietary fiber supplementation is more effective in reducing both symptom and complication frequency than simple dietary fiber supplementation. Long term administration of the poorly absorbed antibiotic Rifaximin is safe and well tolerated by the patients, confirming the usefulness of this therapeutic strategy in the overall management of diverticular disease. Â© 2007 The WJG Press. All rights reserved.

2007 - Prospective evaluation of aberrant p16 methylation in serum of patients before and after therapy for localized HCC [Abstract in Atti di Convegno]
Ferrara, F.; Lodato, Francesca; Chieco, Pasquale; Mantovani, Vilma; Colecchia, Antonio; Roda, Enrico; Brillanti, Stefano
abstract

2007 - Terapia dell'encefalopatia epatica [Capitolo/Saggio]
Festi, D.; Vestito, A.; Pasqui, F.; Colecchia, A.
abstract

Per encefalopatia epatica si intende la comparsa di alterazioni neuropsichiche conseguenti all'insufficienza epatica acuta e cronic, allo shunt porto-sistemico, o ad entrambe. vengono identificati tre tipi di encefalopatia (A,B e C) rispettivamente associati all'encefalopatia epatica acuta, al by-pass porto-sistemico o alla cirrosi epatica.

2006 - A statistical model predicting high hepatocyte proliferation index and the risk of developing hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis [Articolo su rivista]
Azzaroli, Francesco; Colecchia, Antonio; Lodato, Francesca; Trere', Davide; BACCHI REGGIANI, MARIA LETIZIA; Festi, Davide; Prati, Gm; Accogli, E; Casanova, Silvia; Derenzini, Massimo; Roda, Enrico; Mazzella, Giuseppe
abstract

2006 - Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, constipation variant. Result of an open, uncontrolled , multicenter trial [Articolo su rivista]
Colecchia, Antonio; Vestito, Amanda; Larocca, A; Pasqui, Francesca; Nikiforaki, A; Festi, Davide
abstract

2006 - Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, constipation-variant: Results of an open, uncontrolled multicenter study [Articolo su rivista]
Colecchia, A.; Vestito, A.; La Rocca, A.; Pasqui, F.; Nikiforaki, A.; Festi, D.; Abruzzo, F.; Almureden, N.; Angiolucci, A.; Arrigoni, A.; Balzano, A.; Brandimarte, G.; Buono, M.; Calcamuggi, G.; Cammarota, G.; Campana, G.; Cotticeli, G.; Cuomo, R.; D'Amore, F.; De Felici, I.; Dell'Anna, A.; Di Bona, A.; Di Cesare, D.; Di Napoli, A.; Sughera, L.; Febbraio, I.; Ferrini, G.; Fornaciari, G.; Gallo, S.; Glielmo, G.; Iafrancesco, G.; La Barbera, M.; Lavanda, R.; Manca, A.; Matarazzo, F.; Mazzei, C.; Monastra, S.; Montalto, M.; Morace, F.; Murgia, R.; Pagano, N.; Pio, A.; Panarese, A.; Paraocchi, D.; Peccetti, A.; Perasso, A.; Perego, M.; Piscopo, R.; Rizzi, S.; Romano, M.; Rosati, S.; Santoro, G.; Surrenti, E.; Villa, E.
abstract

Aim. Irritable bowel syndrome (IBS) is frequently associated with an imbalance in intestinal bacteria. To date, few studies have evaluated the efficacy and safety of probiotic administration in patients with constipation-variant IBS. A new agent recently available in clinical practice is a symbiotic consisting of a probiotic, Bifidobacterium longum W11, and the short chain oligosaccharide prebiotic Fos Actilight. The aim of this study was to evaluate the efficacy and safety of this symbiotic in patients with constipation-variant IBS. Methods. A total of 636 patients (250 men, 386 women) diagnosed with constipation-type IBS according to the Roma II criteria were enrolled in 43 centers and received the symbiotic at a dose of 3 g/die for at least 36 days. A validated questionnaire investigating symptoms and stool frequency was administered before and after treatment. Results. Based on patient responses to visual scale items, frequency increased significantly after treatment in the "no symptom" class from 3% to 26.7% for bloating and from 8.4% to 44.1% for abdominal pain (P<0.0001). In the more severe symptoms classes (moderate-severe), symptom frequency dropped significantly from 62.9% to 9.6% and from 38.8% to 4.1% for bloating and abdominal pain, respectively. Stool frequency significantly increased from 2.9Â±1.6 tunes/week to 4.1Â±1.6 times/week. Conclusions. The study product can increase stool frequency in patients with constipation-variant IBS and reduce abdominal pain and bloating in those with moderate-severe symptoms.

2006 - Hepatocellular carcinoma prevention: a worldwide emergence between the opulence of developed countries and the economic constraints of developing nations [Articolo su rivista]
Lodato, F; Mazzella, Giuseppe; Festi, Davide; Azzaroli, Francesco; Colecchia, Antonio; Roda, Enrico
abstract

2006 - Intestinal microflora and motility in gallstones before and after cholecystectomy: any role for gallstone pathogenesis? [Abstract in Atti di Convegno]
Festi, D.; Colecchia, A.; Azzaroli, F.; Vestito, A.; Nikiforaki, A.; Aldini, R.; Mazzella, G.; Montagnani, M.; Roda, E.
abstract

2006 - Is it possible to predict the clinical course of gallstone disease? Usefulness of gallbladder motility evaluation in a clinical setting [Articolo su rivista]
Colecchia, A; Sandri, L; Bacchi-Reggiani, Ml; Portincasa, P; Palasciano, G; Mazzella, G; Roda, E; Festi, D
abstract

2006 - MALDI-TOF MS protein profiling using selective extraction with derivatized cellulose and chemometric analysis: from hepatitis C to hepatocellular carcinoma [Relazione in Atti di Convegno]
Parisi, D.; Nanni, P.; Casale, M.; Colecchia, A.; Festi, D.; Roda, E.; Roda, . A.
abstract

2006 - Management of hepatic encephalopathy: focus on antibiotic therapy [Articolo su rivista]
Festi, Davide; Vestito, Amanda; Mazzella, Giuseppe; Roda, Enrico; Colecchia, Antonio
abstract

Altered gut microecology is considered a key pathogenetic factor in the development of both inteststinal (irritable bowel disease, inflammatory bowel disease, ecc.)and systemic (hepatic encephalophaty, steatohepatitis, ecc.) diseases. Hepatic encephalopathy (HE) is a major neuropsychiatric complication of both acute and chronic liver failure. Symptoms of HE include attention deficits, alterations of sleep patterns and muscular incoordination progressing to stupor and coma. The pathogenesis of HE is still unknown, although ammonia-induced alterations of cerebral neurotransmitter balance, especially at the astrocyte-neurone interface, may play a major role. Treatment of HE is therefore directed at reducing the production and absorption of gut-derived neurotoxic substances, especially ammonia. The non-absorbable disaccharides lactulose and lactitol were long considered as a first-line pharmacological treatment of HE, but a recent systematic review questioned their efficacy, pointing out that there is insufficient high-quality evidence to support their use. Oral antibiotics are regarded as a suitable therapeutic alternative. However, the prolonged use of antimicrobials is precluded by the possible occurrence of adverse events. Rifaximin, a synthetic antibiotic structurally related to rifamycin, displays a wide spectrum of antibacterial activity against Gram-negative and Grampositive bacteria, both aerobic and anaerobic, and a very low rate of systemic absorption. Available evidence suggests that rifaximin - thanks to its efficacy and remarkable safety - has the highest benefit-risk ratio in the overall treatment of HE.

2006 - Modulation of placental bilirubin and bile acids transporters during cholestasis of pregnancy [Relazione in Atti di Convegno]
Azzaroli, F.; Mennone, A.; Feletti, V.; Simoni, P.; Magliuolo, M.; Baglivo, E.; Rizzo, N.; Lodato, F.; Festi, D.; Colecchia, A.; Roda, A.; Roda, E.; Boyer, J. L.; Mazzella., G.
abstract

2006 - Salivary TUDCA concentration profiles after TUDCA oral load: a non-invasive test for intestinal transit time evaluation [Relazione in Atti di Convegno]
Roda, A.; Simoni, P.; Magliulo, M.; Vestito, A.; Festi, D.; Colecchia, A.; Roda, E.
abstract

2006 - Systemic lupus erythematosus following virological response to peginterferon alfa-2b in a transplanted patient with chronic hepatitis C recurrence [Articolo su rivista]
Lodato, F; Tame, Mr; Colecchia, A; Racchini, C; Azzaroli, F; D'Errico, A; Casanova, S; Pinna, A; Roda, E; Mazzella, G.
abstract

2006 - The foetal-maternal circulation of bile acids and bilirubin: effects of cholestasis and UDCA administration [Relazione in Atti di Convegno]
Azzaroli, F.; Baglivo, E.; Montagnani, M.; Feletti, V.; Simoni, P.; Locatelli, M.; DE ALOYSIO, D.; Pelusi, G.; Lodato, F.; Festi, D.; Colecchia, A.; Roda, A.; Roda, E.; Mazzella., G.
abstract

2006 - The foetal-maternal circulation of bile acids and bilirubin: effects of cholestasis and UDCA administration [Relazione in Atti di Convegno]
Baglivo, E.; Azzaroli, F.; Montagnani, M.; Feletti, V.; Simoni, P.; Locatelli, M.; DE ALOYSIO, D.; Pelusi, G.; Lodato, F.; Festi, D.; Colecchia, A.; Roda, A.; Roda, E.; Mazzella, G.
abstract

2006 - The safety of Sonovue® in abdominal applications: Retrospective analysis of 23188 investigations [Articolo su rivista]
Piscaglia, F.; Bolondi, L.; Aiani, L.; Luigi Angeli, M.; Arienti, V.; Barozzi, L.; Basilico, R.; Bertolotto, M.; Biasini, E.; Busilacchi, P.; Calliada, F.; Caremani, M.; Caturelli, E.; Celli, N.; Colecchia, A.; Cova, L.; Assunta Cova, M.; Crocetti, L.; de Sio, I.; Drudi, F.; Ferraioli, G.; Filice, C.; Fornari, F.; Gaiani, S.; Giangregorio, F.; Giorgio, A.; Ierace, T.; Lencioni, R.; Livraghi, T.; Magnolfi, F.; Martegani, A.; Meloni, F.; Menozzi, G.; Pelosi, G.; Pompili, M.; Riccardi, L.; Ricci, P.; Rubaltelli, L.; Sacerdoti, D.; Serafini, G.; Serra, C.; Solbiati, L.; Tacconi, D.; Valentino, M.; Vidili, G.; Vitali, F.
abstract

The aim of the present retrospective study was to assess the incidence of adverse events (AE) of a second-generation ultrasound contrast agent in real clinical practice. A total of 28 Italian Centres provided data on the postmarketing use of SonoVue® (Bracco Spa, Milan, Italy) in abdominal examination performed between December 2001 and December 2004. A total of 23 188 investigations were reported. No fatal event occurred. AEs were reported in 29 cases, of which only two were graded as serious; the rest, 27, were nonserious (23 mild, three moderate and one severe). The overall reporting rate of serious AE was 0.0086%. Overall, only four AEs required treatment (two serious, two nonserious including one moderate and one severe AEs). In conclusion, the present large-scale retrospective analysis showed that SonoVue has a good safety profile in abdominal applications, with an AE reporting rate lower than or similar to that reported for radiologic and magnetic resonance contrast agents. (E-mail: Piscagl@med.unibo.it). © 2006 World Federation for Ultrasound in Medicine & Biology.

2006 - Ursodeoxycholic acid improves gastrointestinal motility defects in gallstone patients [Articolo su rivista]
Colecchia, Antonio; Mazzella, Giuseppe; Sandri, L; Azzaroli, Francesco; Magliulo, Maria; Simoni, Patrizia; BACCHI REGGIANI, MARIA LETIZIA; Roda, Enrico; Festi, Davide
abstract

Aim: To simultaneously evaluate the presence of defects in gallbladder and gastric emptying, as well as in intestinal transit in gallstone patients (GS) and the effect of chronic ursodeoxycholic acid (UDCA) administration on these parameters and on serum bile acids and clinical outcome in GS and controls (CTR). Methods: After a standard liquid test meal, gallbladder and gastric emptying (by ultrasound), oroileal transit time (OITT) (by an immunoenzymatic technique) and serum bile acids (by HPLC) were evaluated before and after 3 mo of UDCA (12 mg/kg bw/d) or placebo administration in 10 symptomatic GS and 10 matched healthy CTR. Results: OITT was longer in GS than in CTR (P < 0.0001); UDCA significantly reduced OITT in GS (P < 0.0001), but not in CTR. GS had longer gastric half-emptying time (t 1/2) than CTR (P < 0.0044) at baseline; after UDCA, t 1/2 significantly decreased (P < 0.006) in GS but not in CTR. Placebo administration had no effect on gastric emptying and intestinal transit in both GS and CTR. Conclusion: The gallstone patient has simultaneous multiple impairments of gallbladder and gastric emptying, as well as of intestinal transit. UDCA administration restores these defects in GS, without any effect in CTR. These results confirm the pathogenetic role of gastrointestinal motility in gallstone disease and suggest an additional mechanism of action for UDCA in reducing bile cholesterol supersaturation.

2005 - Correlazione materno-fetale degli acidi biliari in corso di colestasi gravidica [Relazione in Atti di Convegno]
Baglivo, E.; Azzaroli, F.; Locatelli, M.; Feletti, V.; Simoni, P.; Santarsiero, G.; Franchina, M.; Rizzo, N.; Lodato, ; Montagnani, M.; Colecchia, A.; Festi, D.; Roda, A.; Roda, E.; Mazzella, G.
abstract

2005 - Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, costipation-variant: results of a multicenter trial [Relazione in Atti di Convegno]
Colecchia, A.; Vestito, A.; Pasqui, F.; Brandimante, G.; Nikiforak, A.; Festi, D.
abstract

2005 - Genetic polymorphisms of PPAR-alpha: allele frequency in gallstone patients [Relazione in Atti di Convegno]
Montagnani, M.; Ravaioli, E.; Aldini, R.; Righetti, R.; BACCHI-REGGIANI, M. L.; Festi, D.; Azzaroli, F.; Colecchia, A.; Mazzella, G.; Minni, F.; Roda., E.
abstract

2005 - Higher doses of peginterferon alpha-2b administered twice weekly improve sustained virological response in difficult-to-treat patients with chronic hepatitis C: results of a pilot randomized study [Articolo su rivista]
Lodato, F; Azzaroli, F; Brillanti, S; Colecchia, A; Tamé, Mr; Montagnani, M; Muratori, R; Giovanelli, S; Feletti, V; Bacchi Reggiani, Ml; Roda, E; Mazzella, G
abstract

SUMMARY: Beside substantial progress in treatment of chronic hepatitis C (CHC) particular patients (genotype 1/4, high viral load, previous nonresponse, cirrhosis) remain difficult to treat. The aim of our pilot randomized study was to compare efficacy and tolerability of standard doses of Peginterferon alpha-2b + ribavirin with higher doses of Peginterferon alpha-2b administered twice weekly + ribavirin. Sixty-five outpatients with CHC were subsequently enrolled. Group A (n = 22) received recommended doses of Peginterferon alpha-2b and group B (n = 43), received high doses twice weekly. Groups were comparable for baseline characteristics. All genotype 1/4 patients had high baseline viraemia. Sustained virological response (SVR) was significantly higher in group B among naive patients (72%vs 25%, P = 0.024). A significantly higher rate of SVR was observed in group B both considering only genotype 1/4 patients, (46%vs 13%, P = 0.03) and grouping together genotype 1/4 naive and relapsers (57%vs 11%, P = 0.039). Discontinuation rate was 32% (7 of 22) in group A and 19% (8 of 43) in group B. Our response rates are the highest reported for genotype 1/4 with high viraemia. Our pilot study supports the need of randomized studies to evaluate both viral kinetics and efficacy of high dose and twice weekly administration of Peginterferon alpha-2b in genotype 1/4 patients with high viraemia who may need personalized treatment schedules.

2005 - Mathematical model predicting high hepatocyte proliferation index and risk of HCC in patients with HCV related cirrhosis: a proposal for clinical validation [Abstract in Atti di Convegno]
Azzaroli, Francesco; Colecchia, Antonio; Lodato, Francesca; Montagnani, Marco; BACCHI REGGIANI, MARIA LETIZIA; Festi, Davide; Feletti, Valentina; Prati, G. M.; E., Accogli; Casanova, Silvia; Derenzini, Massimo; Roda, Enrico; Mazzella, Giuseppe
abstract

2005 - Measurement of hepatic functional mass by means of 13C-methacetin and 13C-phenylalanine breath tests in chronic liver disease: comparison with Child-Pugh score and serum bile acid levels [Articolo su rivista]
Festi, Davide; Capodicasa, S.; Sandri, L.; COLAIOCCO FERRANTE, L.; Staniscia, T.; Vitacolonna, E.; Vestito, Amanda; Simoni, Patrizia; Mazzella, Giuseppe; Portincasa, P.; Roda, Enrico; Colecchia, Antonio
abstract

AIM: To evaluate and compare the clinical usefulness of 13C-phenylalanine and 13C-methacetin breath tests in quantitating functional hepatic mass in patients with chronic liver disease and to further compare these results with those of conventional tests, Child-Pugh score and serum bile acid levels. METHODS: One hundred and forty patients (50 HCV-related chronic hepatitis, 90 liver cirrhosis patients) and 40 matched healthy controls were studied. Both breath test and routine liver test, serum levels of cholic and chenodeoxycholic acid conjugates were evaluated. RESULTS: Methacetin breath test, expressed as 60 min cumulative percent of oxidation, discriminated the hepatic functional capacity not only between controls and liver disease patients, but also between different categories of chronic liver disease patients. Methacetin breath test was correlated with liver function tests and serum bile acids. Furthermore, methacetin breath test, as well as serum bile acids, were highly predictive of Child-Pugh scores. The diagnostic power of phenylalanine breath test was always less than that of methacetin breath test. CONCLUSION: Methacetin breath test represents a safe and accurate diagnostic tool in the evaluation of hepatic functional mass in chronic liver disease patients.

2005 - Pharmacological modulation of MRP2 in primary biliary cirrhosis [Relazione in Atti di Convegno]
Azzaroli, F.; Colecchia, A.; Guardigli, M.; Roda, A.; Marangi, M.; Casanova, S.; Feletti, V.; Lodato, F.; Montagnani, M.; Festi, D.; Roda, E.; Mazzella, G.
abstract

2005 - Regolazione dei trasportatori placentari degli acidi biliari MRP2, MRP3, MRP4 da parte dell’acido ursodesossicolico in corso di colestasi gravidica [Relazione in Atti di Convegno]
Azzaroli, F.; Feletti, V.; Simoni, P.; Magliuolo, M.; Baglivo, E.; Rizzo, N.; Santarsiero, G.; Franchina, M.; Lodato, F.; Festi, D.; Colecchia, A.; Roda, A.; Roda, E.; Boyer, Jl; Mazzella, G.
abstract

2004 - Breath tests with stable isotopes: have they a role in liver transplantation? [Articolo su rivista]
Festi, D; Capodicasa, S; Vestito, A; Mazzella, G; Roda, E; Vitacolonna, E; Petrolati, A; Angelico, M; Colecchia, A.
abstract

2004 - CMV infection and biliary tract complications are related with a poor outcome of liver transplantation for HCV-related cirrhosis [Abstract in Atti di Convegno]
Giovanelli, S.; D’Errico, A.; Lodato, F.; Colecchia, A.; Tamé, M. R.; Azzaroli, F.; Vetrone, G.; Del Gaudio, M.; Grazi, G. L.; Roda, E.; Mazzella, G.
abstract

2004 - Effect of chronic administration of ursodeoxycholic acid on gallbladder and gastro-intestinal motility in gallstone patients and healthy controls [Relazione in Atti di Convegno]
Colecchia, A.; Sandri, L.; Simoni, P.; Azzaroli, F.; Vestito, A.; Mazzella, G.; Roda, A.; Roda, E.; Festi, D.
abstract

2004 - Efficacy of ursodeoxycholic acid administration on clinical manifestations of gallstones and gastrointestinal motility [Relazione in Atti di Convegno]
Colecchia, A.; Sandri, L; Simoni, P.; Azzaroli, F; Vestito, A; Mazzella, G; Roda, A; Roda, E; Festi, D
abstract

2004 - Hepatic steatosis in obese patients: clinical aspects and prognostic significance [Articolo su rivista]
Festi, Davide; Colecchia, Antonio; Sacco, T; Bondi, M; Roda, Enrico; MARCHESINI REGGIANI, Giulio
abstract

SUMMARY Non-alcoholic fatty liver disease is a clinico-pathological condition of emerging identity and importance, now recognized as the most common cause of abnormal liver tests. It is characterized by a wide spectrum of liver damage: simple steatosis may progress to advanced fibrosis and to cryptogenic cirrhosis through steatohepatitis, and ultimately to hepatocellular carcinoma. Obesity is the single most significant risk factor for the development of fatty liver, both in children and in adults; obesity is also predictive of the presence of fibrosis, potentially progressing to advanced liver disease. From a pathogenic point of view, insulin resistance has a central role in the accumulation of triglycerides within the hepatocytes and in the initiation of the inflammatory cascade. Chronic hepatocellular injury, necroinflammation, stellate cell activation, progressive fibrosis and ultimately, cirrhosis may be initiated by peroxidation of hepatic lipids and injury-related cytokine release. In the last few years several pilot studies proved that treatments with insulin-sensitizing agents, antioxidants or cytoprotective drugs may be useful, but there is no evidence-based support from randomized clinical trials. Lifestyle modifications (e.g., diet and exercise) to reduce obesity remain the mainstay of prevention and treatment of a disease which poses a large number of persons at risk of advanced liver disease in the next future.

2004 - Interferon plus ribavirin and interferon alone in preventing hepatocellular carcinoma: a prospective study on patients with HCV related cirrhosis [Articolo su rivista]
Azzaroli, F; Accogli, E; Nigro, G; Trere, D; Giovanelli, S; Miracolo, A; Lodato, F; Montagnani, M; Tamé, M; Colecchia, A; Mwangemi, C; Festi, D; Roda, E; Derenzini, M; Mazzella, G
abstract

AIM: To determine the role of interferon (IFN) with or without ribavirin in preventing or delaying hepatocellular carcinoma (HCC) development in patients with hepatitis C virus (HCV) related cirrhosis. Data on the preventive effect of IFN plus ribavirin treatment are lacking. METHODS: A total of 101 patients (62 males and 39 females, mean age 55.1+/-1.4 years) with histologically proven HCV related liver cirrhosis plus compatible biochemistry and ultrasonography were enrolled in the study. Biochemistry and ultrasonography were performed every 6 mo. Ultrasound guided liver biopsy was performed on all detected focal lesions. Follow-up lasted for 5 years. Cellular proliferation, evaluated by measuring Ag-NOR proteins in hepatocytes nuclei, was expressed as AgNOR-Proliferative index (AgNOR-PI) (cut-off = 2.5). Forty-one patients (27 males, 14 females) were only followed up after the end of an yearly treatment with IFN-alpha2b (old treatment control group = OTCG). Sixty naive patients were stratified according to sex and AgNOR-PI and then randomized in two groups: 30 were treated with IFN-alpha2b + ribavirin (treatment group = TG), the remaining were not treated (control group = CG). Nonresponders (NR) or relapsers in the TG received further IFN/ribavirin treatments after a 6 mo of withdrawal. RESULTS: AgNOR-PI was significantly lowered by IFN (P<0.001). HCC incidence was higher in patients with AgNOR-PI>2.5 (26% vs 3%, P<0.01). Two NR in the OTCG, none in the TG and 9 patients in the CG developed HCC during follow-up. The Kaplan-Mayer survival curves showed statistically significant differences both between OTCG and CG (P<0.004) and between TG and CG (P<0.003). CONCLUSION: IFN/ribavirin treatment associated with re-treatment courses of NR seems to produce the best results in terms of HCC prevention. AgNOR-PI is a useful marker of possible HCC development.

2004 - Safety of interferon β treatment for chronic HCV hepatitis [Articolo su rivista]
Festi, Davide; Sandri, L.; Mazzella, G.; Roda, E.; Sacco, T.; Staniscia, T.; Capodicasa, S.; Vestito, A.; Colecchia, A.
abstract

Hepatitis C is a major cause of liver-related morbidity and mortality worldwide. In fact, chronic hepatitis C is considered as one of the primary causes of chronic liver disease, cirrhosis and hepatocellular carcinoma, and is the most common reason for liver transplantation. The primary objectives for the treatment of HCV-related chronic hepatitis is to eradicate infection and prevent progression of the disease. The treatment has evolved from the use of Î±-interferon (IFNÎ±) alone to the combination of IFNÎ± plus ribavirin, with a significant improvement in the overall efficacy, and to the newer PEG-IFNs which have further increased the virological response, used either alone or in combination with ribavirin. Despite these positive results, in terms of efficacy, concerns are related to the safety and adverse events. Many patients must reduce the dose of PEG-IFN or ribavirin, others must stop the treatment and a variable percentage of subjects are not suitable owing to intolerance toward drugs. IFNÎ² represents a potential therapeutic alternative for the treatment of chronic viral hepatitis and in some countries it plays an important role in therapeutic protocols. Aim of the present paper was to review available data on the safety of IFNÎ² treatment in HCV-related chronic hepatitis. The rates of treatment discontinuation and/or dose modification due to the appearance of severe side effects during IFNÎ² are generally low and in several clinical studies no requirements for treatment discontinuation and/or dose modifications have been reported. The most frequent side effects experienced during IFNÎ² treatment are flu-like syndromes, fever, fatigue and injection-site reactions. No differences in terms of side-effect frequency and severity between responders and non-responders have been reported. A more recent study, performed to compare IFNÎ² alone or in combination with ribavirin, confirmed the good safety profile of both treatments. Similar trends of adverse event frequency have been observed in subpopulations such as patients with genotype-1b HCV hepatitis unresponsive to IFNÎ± treatment or with HCV-related cirrhosis and patients with acute viral hepatitis. If further studies will confirm the efficacy of combined IFNÎ² and ribavirin treatment, this regimen could represent a safe and alternative therapeutic option in selected patients.

2004 - Serum TUDCA/UDCA concentration profiles after TUDCA oral load: A new test for intestinal transit time and bacteria overgrowth evaluation [Abstract in Atti di Convegno]
Roda, A.; Simoni, P.; Magliulo, M.; Mirasoli, M.; Dal Piaz, F.; Festi, D.; Colecchia, A.; Roda, E.
abstract

2004 - Superior efficacy of twice a week administration of peginterferon alpha-2b plus ribavirin in obtaining SVR in HCV genotype 1 [Relazione in Atti di Convegno]
Lodato, F.; Azzaroli, F.; Tame', M. R.; Colecchia, A.; Montagnani, M.; Muratori, R.; Giovanelli, S.; Miracolo, A.; Nigro, G.; Mwangemi, C.; Roda, E.; Mazzella, G.
abstract

2003 - Diverticular disease of the colon: new perspectives in symptom development and treatment [Articolo su rivista]
Colecchia, A; Sandri, L; Capodicasa, S; Vestito, A; Mazzella, G; Staniscia, T; Roda E, ; Festi, D
abstract

2003 - Gallbladder cholesterol polyps and cholesterolosis [Articolo su rivista]
Sandri, L; Colecchia, A; Larocca, A; Vestito, A; Capodicasa, S; Azzaroli, F; Mazzella, G; Mwangemi, C; Roda, E; Festi, D.
abstract

2003 - Gallbladder motility and functional gastrointestinal disorders [Articolo su rivista]
Colecchia, A; Sandri, L; Staniscia, T; Vestito, A; Capodicasa, S; Portincasa, P; Mazzella, G; Roda, E; Festi, D
abstract

2003 - Gastric autoimmune disorders in patients with chronic hepatitis C before, during and after interferon-alpha therapy [Articolo su rivista]
Fabbri, C; Jaboli, Mf; Giovanelli, S; Azzaroli, F; Pezzoli, A; Accogli, E; Liva, S; Nigro, G; Miracolo, A; Festi, D; Colecchia, A; Montagnani, M; Roda, E; Mazzella, G
abstract

2003 - Long-term alpha interferon and lamivudine combination therapy in non-responder patients with anti-HBe-positive chronic hepatitis B: results of an open, controlled trial [Articolo su rivista]
Jaboli, Mf; Fabbri, C; Liva, S; Azzaroli, F; Nigro, G; Giovanelli, S; Ferrara, F; Miracolo, A; Marchetto, S; Montagnani, M; Colecchia, A; Festi, D; Reggiani, Lb; Roda, E; Mazzella, G
abstract

2003 - Measurements of gallbladder motor function by ultrasonography: towards standardization [Articolo su rivista]
Portincasa, P; Moschetta, A; Colecchia, A; Festi, D; Palasciano, G
abstract

2003 - Ten year incidence of HCV infection in northern Italy and frequency of spontaneous viral clearance [Articolo su rivista]
Mazzeo, C; Azzaroli, F; Giovanelli, S; Dormi, A; Festi, D; Colecchia, A; Miracolo A, ; Natale, P; Nigro, G; Alberti, A; Roda, E; Mazzella, G
abstract

2002 - Improved liver tests and greater biliary enrichment with high dose ursodeoxycholic acid in early stage primary biliary cirrhosis [Articolo su rivista]
Roda, E; Azzaroli, F; Nigro, G; Piazza, F; Jaboli, F; Ferrara, F; Liva, S; Giovanelli, S; Miracolo, A; Colecchia, A; Festi, D; Mazzeo, C; Bacchi, L; Roda, A; Mazzella, G
abstract

2001 - Ursodeoxycholic acid administration in patients with cholestasis of pregnancy: effects on primary bile acids in babies and mothers [Articolo su rivista]
Mazzella, G; Rizzo, N; Azzaroli, F; Simoni, P; Bovicelli, L; Miracolo, A; Simonazzi G, ; Colecchia, A; Nigro, G; Mwangemi, C; Festi, D; Roda, E
abstract

2000 - Does gallbladder motility relate to biliary symptom frequency in cholesterol gallstone patients? [Articolo su rivista]
Colecchia, A.; Primavera, A.; Larocca, A.; Sandri, L.
abstract

Although gallbladder motility (GM) plays a role in cholesterol gallstone (GS) pathogenesis, its role in the development of biliary symptoms is still debated. GM in symptomatic (S) and asymptomatic (AS) GS patients is evaluated and GM differences in relation to biliary symptom frequency are assessed. Recent biliary symptoms seem to be present with GS with high % emptying (%E), but not with low (%E). If these findings are confirmed in a longitudinal study, the finding of a high %E during GM evaluation could be predictive of biliary pain, which might help physicians in clinical decision making.

2000 - Review: Low caloric intake and gall-bladder motor function [Articolo su rivista]
Festi, D.; Colecchia, A.; Larocca, A.; Villanova, N.; Mazzella, G.; Petroni, M. L.; Romano F, F.; Roda, E.
abstract

Cholelithiasis is the primary expression of obesity in the hepatobiliary system. In obese subjects the risk of developing gallstones is increased due to a higher cholesterol saturation of gall-bladder bile. During weight reduction with very low calorie diets (VLCD) the incidence of gallstones increases, but the mechanism for gallstone formation is not completely understood and several pathogenetic mechanisms have been suggested: increased saturation of bile, increased gall-bladder secretion of mucin and calcium, increased presence of prostaglandins and arachidonic acid. Alterations in gall-bladder motility may contribute to gallstone formation, but few studies have addressed the issue of gall-bladder motility during rapid weight loss and its possible role in gallstone formation. VLCD have been associated with a gall-bladder stasis, as a consequence of reduced gall-bladder stimulation by low fat content of the diets. A threshold quantity of fat (10 g) has been documented to obtain efficient gallbladder emptying. Ursodeoxycholic acid administered during VLCD seems to have a protective role in developing a biliary cholesterol crystals. Gall-bladder emptying was lower in response to low fat meals with respect to relative higher fat meals, before as well as during the VLCD. This may account the possibility of an adaptative response of the gall-bladder motility to a given diet regimen. Adequate fat content of the VLCD may prevent gallstone formation, maintaining adequate gall-bladder motility and may be more economic and physiologically acceptable than administration of a pharmacological agent.

2000 - Review: low caloric intake and gall-bladder motor function. Aliment Pharmacol Ther [Articolo su rivista]
Festi, D; Colecchia, A; Larocca, A; Villanova, N; Mazzella, G; Petroni, Ml; Romano, F; Roda, E
abstract

2000 - Standards for diagnosis of gastrointestinal motility disorders. Section: ultrasonography. A position statement from the Gruppo Italiano di Studio Motilità Apparato Digerente [Articolo su rivista]
Portincasa, P; Colecchia, A; Di Ciaula, A; Larocca, A; Muraca, M; Palasciano, G; Roda, E; Festi, D
abstract

1999 - Clinical manifestations of gallstone disease: evidence from the multicenter Italian study on cholelithiasis (MICOL) [Articolo su rivista]
Festi, D; Sottili, S; Colecchia, A; Attili, A; Mazzella, G; Roda, E; Romano, F; THE MICOL RESEARCH, Group; Loria, Paola
abstract

1999 - Sluggish small bowel motility is involved in determining increased biliary deoxycholic acid in cholesterol gallstone patients [Articolo su rivista]
Azzaroli, F; Mazzella, G; Mazzeo, C; Simoni, P; Festi, D; Colecchia, A; Montagnani, M; Martino, C; Villanova, N; Roda, A; Roda, E
abstract

1998 - Gallbladder motility and gallstone formation in obese patients following very low calorie diets. Use it (fat) to lose it (well) [Articolo su rivista]
Festi, D; Colecchia, A; Orsini, M; Sangermano, A; Sottili, S; Simoni, P; Mazzella G, ; Villanova, N; Bazzoli, F; Lapenna, D; Petroni, Ml; Pavesi, S; Neri, M; Roda, E
abstract

1998 - Ultrasound-guided core-needle biopsy is effective in the initial diagnosis of lymphoma patients [Articolo su rivista]
Zinzani, Pl; Colecchia, A; Festi, D; Magagnoli, M; Larocca, A; Ascani, S; Bendandi, M; Orcioni, Gf; Gherlinzoni, F; Albertini, P; Pileri, Sa; Roda, E; Tura, S
abstract

1995 - Endoscopic ultrasonography in the diagnosis of gastrointestinal amyloid deposits: clinical case report [Articolo su rivista]
Gandolfi, L; Colecchia, A; Leo, P; Caletti, G; Rossi, A; Primerano, A; Torresan, F
abstract

1992 - Detection of helicobacter pylori-like organisms in the stomach of some food-source animals using a monoclonal antibody [Articolo su rivista]
Vaira, D.; Ferron, P.; Negrini, R.; Cavazzini, L.; Holton, J.; Ainley, C.; Londei, M.; Vergura, M.; Rosanna, D.; Colecchia, A.; Taylor, D.; Pieracci, F.; Nenci, I.; Gandolfi, L.; Barbara, L.
abstract

To investigate a possible animal reservoir of Helicobacter pylori, 15 pigs, 15 rabbits and 5 cows slaughtered for consumption were studied. Raised serum IgG levels were found in 93% of the pigs and 87% of the rabbits, but levels were normal in the cattle. In the controlled testings three of 22 humans had elevated IgG to H pylori and in all three H pylori was detected by the use of monoclonal antibody. Helicobacter pylori were identified in gastric brushings by a monoclonal antibody in 8 out of 10 pigs and 7 out of 10 rabbits. This study suggests an animal reservoir of Helicobacter pylori which may be of importance in human infection.

1991 - Natural history of hepatic haemangiomas: clinical and ultrasound study [Articolo su rivista]
Gandolfi, L; Leo, P; Solmi, L; Vitelli, E; Verros, G; Colecchia, A
abstract

1991 - Recent advances of diagnostic ultrasonography in gastroenterology in Imaging and Computing in Gastroenterology [Capitolo/Saggio]
Gandolfi, L; Muratori, R; Solmi, L; Colecchia, A
abstract

1991 - Transmission and sources of helicobacter pylori [Capitolo/Saggio]
Vaira, D; Holton, J; Oderda, G; Taylor, D; Turner, R; Colecchia, A; Gandolfi, L
abstract

Università degli studi di Modena e Reggio Emilia

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