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Background and Aims: Post-surgical recurrence of Crohn's disease (CD) after ileocolonic resection is common. Early identification of features associated with recurrence is a standard procedure of postoperative management, but the prognostic role of such features when detected at later time points is unclear. We compared the predictivity for Crohn's disease recurrence of common clinical-instrumental variables when assessed early (<12 months) or late (>36 months) after surgery., Methods: This retrospective study considered CD patients who had ileocolonic resection and were followed for a median of 7.6 years. Clinical characteristics, post-surgical therapy, endoscopy recurrence (Rutgeerts' score ≥i2) and ultrasound features were compared between subgroups who had a early or late post-surgical assessment. Univariate and multivariate analyses were done to identify variables associated with recurrence (clinical and surgical)., Results: Of 201 patients, 70 (32%) had a early and 39 (19%) had a late post-surgical assessment. The Early and Late subgroups had similar clinical characteristics. Overall, clinical relapse was observed in 131 patients (66%), surgical relapse in 31 (16%), endoscopic recurrence in 149 (75%) and ultrasonographic recurrence in 132 (66%), without significant differences in frequencies between subgroups. By Cox proportional hazard regression, endoscopic recurrence was a significant predictor of clinical recurrence overall (HR=2.31, P = 0.002) and in the Early (HR=3.85, P = 0.002) but not Late subgroup., Discussion: The most informative postoperative CD assessment is the one done within the first year of surgery. Later endoscopic evaluations have no prognostic value and should be done only for clinical needs or for research purposes., Competing Interests: Declaration of Competing Interest GDP, MM, MM, CR, PM, MC, CR, EM, EE, AL, RR, AF: reported no conflict of interest to disclose CG: Roche boards MD: Advisory board/Lecturer/Grants/Congress participation from Abbvie, Takeda, Janssen, Ferring, MSD, Mundipharma, Pfizer, SOFAR, Chiesi, Roche, Bioclinica, (Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Inflammatory bowel disease is treated with anti-TNF agents such as infliximab and its biosimilars, but use of biosimilars is limited due to perceived risks of adverse events., Aim: To explore safety and effectiveness of switching from the infliximab originator to a first biosimilar., Patients and Methods: Clinical and biological outcomes were compared between 53 patients who switched from the infliximab originator to the biosimilar CT-P13 (Switched group) and 13 patients treated with CT-P13 from the beginning (Naïve group). Infliximab trough levels and antidrug antibodies were measured., Results: At enrolment, patients in the Switched group had a longer median duration of infliximab treatment than Naïve (4.0 vs. 0.6 years, p < 0.0001) but similar proportions of patients were in remission (77% and 62%, respectively). Infliximab discontinuation due to adverse events or loss of efficacy was less common in the Switched (26%) than Naïve group (62%, p = 0.017). Variables independently associated with time to discontinuation were disease activity (p < 0.0001) and immunomodulating treatment (p = 0.019) at enrolment. Trough levels and antidrug antibodies were similar between groups during observation., Conclusion: This study confirms that switching from infliximab originator to a first biosimilar is safe and effective. Patients at highest risk of losing treatment efficacy are those with active disease, irrespective of the therapeutic switch., (Copyright © 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Treatment with infliximab is a common option for inflammatory bowel disease (IBD) patients. Therapeutic drug monitoring could improve treatment management., Aims: To test inter-test reliability of two commercially available diagnostic kits for infliximab trough levels and infliximab antibodies, and their association with treatment outcomes., Methods: 86 IBD outpatients on infliximab maintenance treatment were enrolled in a prospective cross-sectional study, 115 samples were available for inter-test reliability., Results: Inter-test agreement was good both for trough levels (concordance correlation coefficient 0.78, weighted κ 0.60, Sperman's ρ 0.937) and for infliximab antibodies (weighted κ 0.79) measurement, when comparing Promonitor and ImmunDiagnostik kits. According to manufacturers' cut-off values, trough levels were classified as undetectable (17%), low (21%) or in range (63%). The only significant associations were: mucosal healing (p=0.026; OR 6.50), infliximab antibody status (p=0.0015; OR 0.031) and adverse events (p=0.009; OR 0.115). Higher trough levels were observed among patients on concomitant steroid/immunosuppressive therapy and among patients with dose-intensification. Infliximab antibodies were significantly associated to treatment-related adverse events (p=0.0003, OR 30.42), and to lower trough levels, but not to other clinical variables., Conclusion: The two tests performed equally well. Infliximab antibodies were associated to adverse events, while trough levels were not associated to treatment outcomes., (Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Cecal intubation is one of the targets of colon endoscopic evaluation, however even under experienced hands 5-10% of colonoscopies are incomplete., Aims: The aim of the study is to evaluate the usefulness of single balloon enteroscope (SBE) without employing overtube-balloon equipment in patients with incomplete colonoscopy., Methods: Between January 2009 and July 2010, patients with an incomplete standard colonscopy were prospectively enrolled to perform a colonoscopy with a single balloon enteroscope. Examinations were performed by the same expert operator during the same session., Results: Enteroscopy was performed on 79 patients, cecal intubation were obtained in 93.6% of the cases (74/79). It provided a new diagnosis in 43% of cases (34/79). Procedure was safe and well tolerated. Overall the additional use of single balloon enteroscope allowed to obtain the cecal intubation in up to 99.2% cases (898/905)., Conclusions: The use of the enteroscope without overtube-balloon equipment may be an effective method to increase the cecal intubation rate after failure of a standard colonoscopy., (Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)