Minerva gastroenterology最新文献

Acute pancreatitis (AP) is a commonly encountered GI diagnosis, accounting for 275,000 hospital admissions annually in the United States alone. Pancreatic necrosis (PN) is the most common complication of AP, and the development of PN is associated with significant morbidity and increased mortality. This expert review evaluates the evidence-based management of symptomatic PN from the era of maximal open pancreatic necrosectomy in the late 1990s though the modern paradigm of minimally invasive and endoscopic interventions. The authors present the retrospective and controlled data behind the "step-up approach" to PN treatment and discuss the application of current society guidance. Evidence based management of PN is characterized by early supportive care, and treatment by minimally invasive intervention when a patient is critically ill or persistently symptomatic. Appropriate choices when intervention is required include percutaneous drainage, minimally invasive surgery, and/or endoscopic treatment. The transition from open maximal necrosectomy to minimally invasive intervention has resulted in improved outcomes for patients, including gains in mortality, significant morbidity, and cost. The ideal precision management strategy for an individual patient remains an area of increasing understanding.

Background: It is known that the subcutaneous (SC) route administration of biologic drugs has several potential benefits for patient and the healthcare system. Since few real-world data are available yet about the rate of transition from intravenous (IV) to SC Vedolizumab (VDZ) in the Italian population, we assessed this rate in a large cohort of inflammatory bowel disease (IBD) patients under remission receiving IV VDZ as standard of care in a real-world setting.

Methods: Searching who was asked to switch from IV VDZ To SC VDZ, and assessing the rate of acceptance. The Mayo score in Ulcerative colitis (UC) and the Harvey-Bradshaw Index (HBI) in Crohn's Disease (CD) scored the clinical activity. Achievement and maintenance of clinical remission during the follow-up, and safety were the primary endpoints.

Results: Overall, 238 patients (145 with UC and 93 with CD) having remission ≥1 year with VDZ were asked to switch to VDZ SC, but only nine patients (four with UC and five with CD, 3.78% of the total population to which the switch was proposed) agreed to switch. No difference were found between patients accepting and patients refusing switching about the reasons of the choice. All patients accepting switch maintained clinical remission during the follow-up, and no adverse events were recorded.

Conclusions: Switching to SC route is a safe and effective choice for IBD patients under remission using VDZ. However, this choice is not preferred by the majority of patients on stable remission under IV VDZ.

Background: Biological agents were found to alter the psychopathological profile of a small subgroup of patients treated for a variety of conditions, including inflammatory bowel disease (IBD) and psychiatric disorders. The association between the administration of biological agents and psychopathology needs to be further investigated.

Methods: In this naturalistic prospective cohort study, patients with IBD were assigned to two treatment groups, i.e., a biological agent (which also included tofacitinib) or conventional therapy. Clinician-administered scales were used to assess psychosomatic symptoms (Hamilton Depression Rating Scale [Ham-D], Hamilton Anxiety Rating Scale [Ham-A], Young Mania Rating Scale [YMRS], and Brief Psychiatric Rating Scale [BPRS]) and disease activity (Mayo Score and Harvey-Bradshaw Index [HBI]) at baseline, after one, three, and six months of treatment. Each group was assessed for the course of their scores during the observation period at each assessment point.

Results: Patients on biological drugs who completed three months of treatment (N.=32) and six months of treatment (N.=20) scored significantly lower on the Mayo compared to baseline. Patients on conventional treatment obtained significant drops from baseline on the HBI after one and three months of treatment (N.=30) and also at the six-month endpoint (N.=11). Both groups showed no improvement or worsening on the psychiatric rating scales.

Conclusions: In this study, we found no evidence of psychiatric symptom worsening, as some literature would suggest. Our data suggest that the use of biological agents in IBD is safe.