Publications by authors named "Mariangela Allocca"

A 62-year-old woman presented with multiple ileal and colonic stenoses, initially suspected to be Crohn's disease. Despite unremarkable endoscopic biopsies, surgery was performed due to clinical deterioration, and histological analysis confirmed the presence of metastatic breast cancer. This case highlights the importance of considering metastatic disease in the differential diagnosis of gastrointestinal (GI) strictures, particularly when inflammatory bowel disease markers are inconclusive or marginal.

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Introduction: IBD-Disk is a simple, easy-to-use, and self-administered analogue visual tool for assessing disability in patients with Inflammatory Bowel Disease (IBD). However, it has not yet been validated in Italian. This study aims to validate IBD-Disk in an Italian cross-sectional multicentre study.

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Introduction: Crohn's disease (CD) is a chronic inflammatory bowel disease affecting the entire gastrointestinal tract with a progressive and relapsing course. Achieving mucosal healing has emerged as a critical therapeutic goal, as it is associated with sustained clinical remission, reduced hospitalizations, and fewer surgery rates. Therefore, targeting mucosal healing is essential for long-term control in CD.

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Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by growing incidence and prevalence around the world in the last few decades. The range of available existing treatment and strategies for its management is being implemented. Given the introduction of newly developed molecules and the lack of specific guidelines, drug positioning may represent a tough clinical challenge.

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Gut microbiota dysbiosis has a critical role in the pathogenesis of inflammatory bowel diseases, prompting the exploration of novel therapeutic approaches like fecal microbiota transplantation, which involves the transfer of fecal microbiota from a healthy donor to a recipient with the aim of restoring a balanced microbial community and attenuating inflammation. Fecal microbiota transplantation may exert beneficial effects in inflammatory bowel disease through modulation of immune responses, restoration of mucosal barrier integrity, and alteration of microbial metabolites. It could alter disease course and prevent flares, although long-term durability and safety data are lacking.

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Infectious diseases affecting the gastrointestinal tract often present diagnostic challenges due to the variability in clinical manifestations and overlapping symptoms. Ultrasound imaging has emerged as a valuable tool in the assessment of gastrointestinal pathologies, offering non-invasive and real-time visualization of anatomical structures. This review aims to explore the role of ultrasound in the diagnosis and management of infectious diseases involving the gastrointestinal tract.

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Patients with inflammatory bowel diseases (IBDs), including both ulcerative colitis (UC) and Crohn's disease (CD), are at a higher risk of developing colorectal cancer (CRC). However, advancements in endoscopic imaging techniques, integrated surveillance programs, and improved medical therapies have led to a decrease in the incidence of CRC among IBD patients. Currently, the management of patients with IBD who have a history of or ongoing active malignancy is an unmet need.

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Article Synopsis
  • - A study on inflammatory bowel disease (IBD) showed that about 24.8% of patients met criteria for "difficult-to-treat" IBD, particularly those with severe forms of ulcerative colitis and Crohn's disease.
  • - Key risk factors included specific disease characteristics, such as left-sided colitis and multiple disease localizations, with delayed treatment initiation linked to worse outcomes in Crohn's disease but protective in ulcerative colitis.
  • - Patients with difficult-to-treat IBD experienced lower rates of remission and decreased drug effectiveness as they progressed through treatment options.
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  • Inflammatory bowel diseases (IBDs) affect the gastrointestinal tract and can lead to extraintestinal manifestations, which can hurt patients' quality of life.
  • Common associated conditions like peripheral arthritis and episcleritis improve with treatments for intestinal inflammation, while others, like ankylosing spondylitis, often occur independently.
  • The review explores the pathophysiology and treatment of these extraintestinal manifestations in Crohn's disease and ulcerative colitis, noting that some advanced IBD therapies may have side effects similar to these conditions.
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Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that frequently affects the small bowel. Individuals diagnosed with CD are at increased risk of developing bowel cancer compared to the general population. Small bowel cancer is a rare but significant CD complication.

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Immune-mediated gastrointestinal (GI) diseases, including achalasia, celiac disease, and inflammatory bowel diseases, pose significant challenges in diagnosis and management due to their complex etiology and diverse clinical manifestations. While genetic predispositions and environmental factors have been extensively studied in the context of these conditions, the role of viral infections and virome dysbiosis remains a subject of growing interest. This review aims to elucidate the involvement of viral infections in the pathogenesis of immune-mediated GI diseases, focusing on achalasia and celiac disease, as well as the virome dysbiosis in IBD.

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Chronic inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, present diagnostic challenges due to their complex and heterogeneous nature. While histology remains fundamental for accurate diagnosis, a multidisciplinary approach incorporating clinical, endoscopic, and imaging modalities is increasingly recognized as essential for comprehensive evaluation. This article delves into the importance of integrating various diagnostic techniques in the assessment of IBD.

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Article Synopsis
  • Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is still challenging to treat, but new drug classes like sphingosine-1-phosphate (S1P) modulators and interleukin-23 (IL-23) inhibitors are showing promise in clinical trials up to 2024.
  • This review summarizes findings from these clinical trials, focusing on drugs such as ozanimod, etrasimod, and various IL-23 inhibitors, all of which have demonstrated effectiveness and safety in managing IBD.
  • Both S1P modulators and IL-23 inhibitors present strong potential for becoming key treatment options in IBD management, but more research is needed on
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  • Subcutaneous formulations of infliximab (IFX) and vedolizumab (VDZ) are effective treatments for inflammatory bowel diseases (IBDs) and this study evaluated the impact of switching from intravenous to subcutaneous forms.
  • The analysis included data from 231 adult patients with Crohn's disease or ulcerative colitis, assessing clinical remission rates at 3, 6, and 12 months post-switch.
  • Results showed that most patients remained in remission after switching, and switching early in the treatment process was associated with a lower risk of negative therapeutic outcomes.
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This article is the second in a series of two publications on the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn's disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations.

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Introduction: Janus kinases (JAK) are enzymes involved in signaling pathways that activate the immune system. Upadacitinib, an oral small molecule, is the first JAK inhibitor approved by FDA and EMA for the treatment of moderately to severely active Crohn's disease (CD), following successful phase II and III trials. Compared to other JAK inhibitors, upadacitinib has a high selectivity toward JAK1.

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Risankizumab is a humanized monoclonal antibody that inhibits the p19 subunit of IL-23 cytokine. Recently it has been approved for the treatment of patients with moderate-to-severe Crohn's disease (CD). We conducted a scoping review to summarize the available data on risankizumab and to define its positioning in the treatment algorithm of CD.

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Article Synopsis
  • * In a study involving 93 patients, those who achieved ultrasound remission at week 12 had a significantly higher chance of long-term endoscopic remission (59%) compared to those without ultrasound remission (41%).
  • * The findings suggest that achieving ultrasound remission early in treatment is important, indicating it should be considered a key treatment goal; further larger studies are needed for validation.
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In recent years, there has been a growing focus on the intricate interplay between the gut microbiota and host health, specifically in the context of inflammatory bowel diseases (IBDs). The gut microbiota produces a diverse array of metabolites, influencing the host's immune response and tissue homeostasis. Noteworthy metabolites, such as short-chain fatty acids, bile acids, and indoles, exert significant effects on intestinal inflammation and fibrosis.

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Background: As acceptance of artificial intelligence [AI] platforms increases, more patients will consider these tools as sources of information. The ChatGPT architecture utilizes a neural network to process natural language, thus generating responses based on the context of input text. The accuracy and completeness of ChatGPT3.

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  • A study compared the effectiveness of tofacitinib and ustekinumab as third-line treatments for patients with moderate to severe ulcerative colitis (UC) who did not respond to earlier therapies (anti-TNF and vedolizumab).
  • Out of 117 patients followed for about 11.6 months, 54% experienced disease progression, with ustekinumab being associated with a higher risk of progression compared to tofacitinib.
  • While tofacitinib showed better results in preventing disease progression, no major differences were noted in secondary outcomes or adverse events, highlighting the need for more extensive clinical trials to validate these findings.
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Background: The dysregulation of the gut-brain axis in chronic inflammatory bowel diseases can cause neuro-psychological disturbances, but the underlying mechanisms are still not fully understood. The choroid plexus (CP) maintains brain homeostasis and nourishment through the secretion and clearance of cerebrospinal fluid. Recent research has demonstrated the existence of a CP vascular barrier in mice which is modulated during intestinal inflammation.

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Article Synopsis
  • * Ustekinumab is a monoclonal antibody targeting IL-12/23, approved for treating IBD in patients unresponsive to standard therapies, while risankizumab is the only specific IL-23p19 antagonist currently approved for Crohn's disease.
  • * Ongoing trials for guselkumab and mirikizumab show promising results, and this review focuses on how these selective IL-23 inhibitors fit into treatment plans for moderate to severe Crohn's disease.
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Crohn's disease (CD) is a chronic inflammatory bowel disease with different phenotypes of presentation, inflammatory, penetrating, or stricturing disease, that significantly impacts patient well-being and quality of life. Despite advances in medical therapy, surgery sometimes represents the only treatment to address complications, such as strictures, fistulas, or abscesses. Minimizing postoperative recurrence (POR) remains a major challenge for both clinicians and patients; consequently, various therapeutic strategies have been developed to prevent or delay POR.

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