32 results on '"Bianchi PI"'
Search Results
2. The significance of duodenal mucosa atrophy in patients with common variable immunodeficiency: a clinical and histopatological study
- Author
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Biagi, F, Bianchi, Pi, Zilli, A, Marchese, A, Luinetti, O, Lougaris, Vassilios, Plebani, Alessandro, Villanacci, V, and Corazza, G. R.
- Subjects
immunodeficiency ,duodenal mucosa - Published
- 2012
3. Gluten sensitivity and the CNS: diagnosis and treatment
- Author
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Versino, M., Biagi, F., Bianchi, Pi., Zardini, E., Colnaghi, S., Moglia, A., and Corazza, Gr
- Published
- 2010
4. The significance of duodenal mucosal atrophy in patients with common variable immunodeficiency: a clinical and histopathologic study.
- Author
-
Biagi F, Bianchi PI, Zilli A, Marchese A, Luinetti O, Lougaris V, Plebani A, Villanacci V, and Corazza GR
- Published
- 2012
- Full Text
- View/download PDF
5. Influence of HLA-DQ2 and DQ8 on Severity in Celiac Disease.
- Author
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Biagi F, Bianchi PI, Vattiato C, Marchese A, Trotta L, Badulli C, De Silvestri A, Martinetti M, and Corazza GR
- Published
- 2012
- Full Text
- View/download PDF
6. A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease.
- Author
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Biagi F, Andrealli A, Bianchi PI, Marchese A, Klersy C, and Corazza GR
- Published
- 2009
- Full Text
- View/download PDF
7. Luke HockleySomatic Cinema: The Relationship between Body and Screen – a Jungian Perspective Routledge, London 2014, pp. 192
- Author
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Bianchi Pietro
- Subjects
Motion pictures ,PN1993-1999 - Published
- 2015
8. Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study
- Author
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Raparelli, Valeria, Pastori, Daniele, Pignataro, Serena Francesca, Vestri, Anna Rita, Pignatelli, Pasquale, Cangemi, Roberto, Proietti, Marco, Davì, Giovanni, Hiatt, William Robert, Lip, Gregory Yoke Hong, Corazza, Gino Roberto, Perticone, Francesco, Violi, Francesco, Basili, Stefania, Alessandri, C., Serviddio, G., Palange, P., Greco, E., Bruno, G., Averna, M., Giammanco, A., Sposito, P., de Cristofaro, R., Carulli, L., de Gennaro, L., Pellegrini, E., Cominacini, L., Mozzini, C., Pasini, A. F., Sprovieri, M., Spagnuolo, V., Cerqua, G., Cerasola, G., Mulé, G., Barbagallo, M., Lo Sciuto, S., Monteverde, A., Saitta, A., Lo Gullo, A., Malatino, L., Cilia, C., Terranova, V., Pisano, M., Pinto, A., Di Raimondo, D., Tuttolomondo, A., Conigliaro, R., Signorelli, S., de Palma, D., Galderisi, M., Cudemo, G., Galletti, F., Fazio, V., de Luca, N., Meccariello, A., Caputo, D., de Donato, M. T., Iannuzi, A., Bresciani, A., Giunta, R., Utili, R., Iorio, V., Adinolfi, L. E., Sellitto, C., Iuliano, N., Bellis, P., Tirelli, P., Sacerdoti, D., Vanni, D., Iuliano, L., Ciacciarelli, M., Pacelli, A., Palazzuoli, A., Cacciafesta, M., Gueli, N., Lo Iacono, C., Brusco, S., Verrusio, W., Nobili, L., Tarquinio, N., Pellegrini, F., Vincentelli, G. M., Ravallese, F., Santini, C., Letizia, C., Petramala, L., Zinnamosca, L., Minisola, S., Cilli, M., Colangelo, L., Falaschi, P., Martocchia, A., Pastore, F., Bertazzoni, G., Attalla El Halabieh, E., Paradiso, M., Lizzi, E. M., Timmi, S., Battisti, P., Cerci, S., Ciavolella, M., Di Veroli, C., Malci, F., de Ciocchis, A., Abate, D., Castellino, P., Zanoli, L., Fidone, F., Mannarino, E., Pasqualini, L., Oliverio, G., Pende, A., Artom, N., Ricchio, R., Fimognari, F. L., Alletto, M., Messina, S., Sesti, G., Arturi, F., Succurro, E., Fiorentino, T. V., Pedace, E., Scarpino, P. E., Carullo, G., Maio, R., Sciacqua, A., Frugiuele, P., Battaglia, G., Atzori, S., Delitala, G., Angelucci, E., Sestili, S., Traisci, G., de Feudis, L., Di Michele, D., Fava, A., Balsano, C., de Ciantis, P., Desideri, G., Camerota, A., Mezzetti, M., Gresele, P., Vedovati, C., Fierro, T., Puccetti, L., Bertolotti, M., Mussi, C., Boddi, M., Savino, A., Contri, S., Degl’Innocenti, G., Saller, A., Fabris, F., Pesavento, R., Filippi, L., Vedovetto, V., Puato, M., Treleani, M., de Luca, E., de Zaiacomo, F., Giantin, V., Semplicini, A., Minuz, P., Romano, S., Fantin, F., Manica, A., Stockner, I., Pattis, P., Gutmann, B., Catena, C., Colussi, G., Sechi, L. A., Annoni, G., Bruni, A. A., Castagna, A., Spinelli, D., Miceli, E., Padula, D., Schinco, G., Spreafico, S., Secchi, B., Vanoli, M., Casella, G., Pulixi, E. A., Sansone, L., Serra, M. G., Longo, S., Antonaci, S., Belfiore, A., Frualdo, M., Palasciano, G., Ricci, L., Ventrella, F., Bianco, C., Santovito, D., Cipollone, F., Nicolai, S., Salvati, F., Rini, G. B., Scozzari, F., Muiesan, M. L., Salvetti, M., Bazza, A., Picardi, A., Vespasiani-Gentilucci, U., de Vincentis, A., Cosio, P., Terzolo, M., Madaffari, B., Parasporo, B., Fenoglio, L., Bracco, C., Melchio, R., Gentili, T., Salvi, A., Nitti, C., Gabrielli, A., Martino, G. P., Capucci, A., Brambatti, M., Sparagna, A., Tirotta, D., Andreozzi, P., Ettorre, E., Viscogliosi, G., Servello, A., Musumeci, M., Delfino, M., Giorgi, A., Glorioso, N., Melis, G., Marras, G., Matta, M., Sacco, A., Stellitano, E., Scordo, A., Russo, F., Caruso, A. A., Porreca, E., Tana, M., Ferri, C., Cheli, P., Portincasa, P., Muscianisi, G., Giordani, S., Stanghellini, V., Sabbà, C., Mancuso, G., Bartone, M., Calipari, D., Arcidiacono, G., Bellanuova, I., Ferraro, M., Marigliano, G., Cozzolino, D., Lampitella, A., Acri, V., Galasso, D., Mazzei, F., Buratti, A., Galasso, S., Porta, M., Brizzi, M. F., Fattorini, A., Sampietro, F., D’Angelo, A., Manfredini, R., Pala, M., Fabbian, F., Moroni, C., Valente, L., Lopreiato, F., Parente, F., Granata, M., Moia, M., Braham, S., Rossi, M., Pesce, M., Gentile, A., Catozzo, V., Baciarello, G., Cosimati, A., Ageno, W., Rancan, E., Guasti, L., Ciccaglioni, A., Negri, S., Polselli, M., Prisco, D., Marcucci, R., Ferro, D., Perri, L., Cangemi, R., Saliola, M., Del Ben, M., Angelico, F., Baratta, F., Migliacci, R., Porciello, G., Corrao, S., Proietti, M., Raparelli, V., Napoleone, L., Talerico, G., Amoroso, D., Romiti, G. F., Ruscio, E., Toriello, F., Sperduti, N., Todisco, T., Di Tanna, G., Sacchetti, M. L., Puddu, P. E., Farcomeni, A., Anzaldi, M., Bazzini, C., Bianchi, P. I., Boari, B., Buonauro, A., Buttà, C., Buzzetti, E., Calabria, S., Capeci, W., Caradio, F., Carleo, P., Carrabba, M. D., Castorani, L., Cecchetto, L., Cicco, S., Cimini, C., Colombo, B. M., de Giorgi, A., de Vuono, S., Del Corso, L., Denegri, A., Di Giosia, P., Durante Mangoni, E., Falsetti, L., Forgione, A., Giorgini, P., Grassi, D., Grembiale, A., Hijazi, D., Iamele, L., Lorusso, G., Marchese, A., Marra, A. M., Masala, M., Miceli, G., Montebianco Abenavoli, L., Murgia, G., Naccarato, P., Pattoneri, P., Perego, F., Pesce, P., Piano, S., Pinna, M., Pinto, D., Pretti, V., Pucci, G., Salinaro, F., Salzano, A., Santilli, F., Scarpini, F., Scicali, R., Sirico, D., Suppressa, P., Talia, M., Tassone, E. J., Torres, D., Vazzana, N., Vecchio, C. R., Vidili, G., Vitale, F., Zaccone, V., ARAPACIS Study Collaborators, Raparelli, V, Pastori, D, Pignataro, S, Vestri, A, Pignatelli, P, Cangemi, R, Proietti, M, Davi, G, Hiatt, W, Lip, G, Corazza, G, Perticone, F, Violi, F, Basili, S, Alessandri, C, Serviddio, G, Palange, P, Greco, E, Bruno, G, Averna, M, Giammanco, A, Sposito, P, Decristofaro, R, Carulli, L, Degennaro, L, Pellegrini, E, Cominacini, L, Mozzini, C, Pasini, A, Sprovieri, M, Spagnuolo, V, Cerqua, G, Cerasola, G, Mule, G, Barbagallo, M, Lo Sciuto, S, Monteverde, A, Saitta, A, Lo Gullo, A, Malatino, L, Cilia, C, Terranova, V, Pisano, M, Pinto, A, Diraimondo, D, Tuttolomondo, A, Conigliaro, R, Signorelli, S, Depalma, D, Galderisi, M, Cudemo, G, Galletti, F, Fazio, V, Deluca, N, Meccariello, A, Caputo, D, Dedonato, M, Iannuzi, A, Bresciani, A, Giunta, R, Utili, R, Iorio, V, Adinolfi, L, Sellitto, C, Iuliano, N, Bellis, P, Tirelli, P, Sacerdoti, D, Vanni, D, Iuliano, L, Ciacciarelli, M, Pacelli, A, Palazzuoli, A, Cacciafesta, M, Gueli, N, Lo Iacono, C, Brusco, S, Verrusio, W, Nobili, L, Tarquinio, N, Pellegrini, F, Vincentelli, G, Ravallese, F, Santini, C, Letizia, C, Petramala, L, Zinnamosca, L, Minisola, S, Cilli, M, Colangelo, L, Falaschi, P, Martocchia, A, Pastore, F, Bertazzoni, G, Attalla El Halabieh, E, Paradiso, M, Lizzi, E, Timmi, S, Battisti, P, Cerci, S, Ciavolella, M, Diveroli, C, Malci, F, Deciocchis, A, Abate, D, Castellino, P, Zanoli, L, Fidone, F, Mannarino, E, Pasqualini, L, Oliverio, G, Pende, A, Artom, N, Ricchio, R, Fimognari, F, Alletto, M, Messina, S, Sesti, G, Arturi, F, Succurro, E, Fiorentino, T, Pedace, E, Scarpino, P, Carullo, G, Maio, R, Sciacqua, A, Frugiuele, P, Battaglia, G, Atzori, S, Delitala, G, Angelucci, E, Sestili, S, Traisci, G, Defeudis, L, Dimichele, D, Fava, A, Balsano, C, Deciantis, P, Desideri, G, Camerota, A, Mezzetti, M, Gresele, P, Vedovati, C, Fierro, T, Puccetti, L, Bertolotti, M, Mussi, C, Boddi, M, Savino, A, Contri, S, Degl'Innocenti, G, Saller, A, Fabris, F, Pesavento, R, Filippi, L, Vedovetto, V, Puato, M, Treleani, M, Deluca, E, Dezaiacomo, F, Giantin, V, Semplicini, A, Minuz, P, Romano, S, Fantin, F, Manica, A, Stockner, I, Pattis, P, Gutmann, B, Catena, C, Colussi, G, Sechi, L, Annoni, G, Bruni, A, Castagna, A, Spinelli, D, Miceli, E, Padula, D, Schinco, G, Spreafico, S, Secchi, B, Vanoli, M, Casella, G, Pulixi, E, Sansone, L, Serra, M, Longo, S, Antonaci, S, Belfiore, A, Frualdo, M, Palasciano, G, Ricci, L, Ventrella, F, Bianco, C, Santovito, D, Cipollone, F, Nicolai, S, Salvati, F, Rini, G, Scozzari, F, Muiesan, M, Salvetti, M, Bazza, A, Picardi, A, Vespasiani-Gentilucci, U, Devincentis, A, Cosio, P, Terzolo, M, Madaffari, B, Parasporo, B, Fenoglio, L, Bracco, C, Melchio, R, Gentili, T, Salvi, A, Nitti, C, Gabrielli, A, Martino, G, Capucci, A, Brambatti, M, Sparagna, A, Tirotta, D, Andreozzi, P, Ettorre, E, Viscogliosi, G, Servello, A, Musumeci, M, Delfino, M, Giorgi, A, Glorioso, N, Melis, G, Marras, G, Matta, M, Sacco, A, Stellitano, E, Scordo, A, Russo, F, Caruso, A, Porreca, E, Tana, M, Ferri, C, Cheli, P, Portincasa, P, Muscianisi, G, Giordani, S, Stanghellini, V, Sabba, C, Mancuso, G, Bartone, M, Calipari, D, Arcidiacono, G, Bellanuova, I, Ferraro, M, Marigliano, G, Cozzolino, D, Lampitella, A, Acri, V, Galasso, D, Mazzei, F, Buratti, A, Galasso, S, Porta, M, Brizzi, M, Fattorini, A, Sampietro, F, D'Angelo, A, Manfredini, R, Pala, M, Fabbian, F, Moroni, C, Valente, L, Lopreiato, F, Parente, F, Granata, M, Moia, M, Braham, S, Rossi, M, Pesce, M, Gentile, A, Catozzo, V, Baciarello, G, Cosimati, A, Ageno, W, Rancan, E, Guasti, L, Ciccaglioni, A, Negri, S, Polselli, M, Prisco, D, Marcucci, R, Ferro, D, Perri, L, Saliola, M, Delben, M, Angelico, F, Baratta, F, Migliacci, R, Porciello, G, Corrao, S, Napoleone, L, Talerico, G, Amoroso, D, Romiti, G, Ruscio, E, Toriello, F, Sperduti, N, Todisco, T, Ditanna, G, Sacchetti, M, Puddu, P, Farcomeni, A, Anzaldi, M, Bazzini, C, Bianchi, P, Boari, B, Buonauro, A, Butta, C, Buzzetti, E, Calabria, S, Capeci, W, Caradio, F, Carleo, P, Carrabba, M, Castorani, L, Cecchetto, L, Cicco, S, Cimini, C, Colombo, B, De Giorgi, A, Devuono, S, Delcorso, L, Denegri, A, Digiosia, P, Durante Mangoni, E, Falsetti, L, Forgione, A, Giorgini, P, Grassi, D, Grembiale, A, Hijazi, D, Iamele, L, Lorusso, G, Marchese, A, Marra, A, Masala, M, Miceli, G, Montebianco Abenavoli, L, Murgia, G, Naccarato, P, Pattoneri, P, Perego, F, Pesce, P, Piano, S, Pinna, M, Pinto, D, Pretti, V, Pucci, G, Salinaro, F, Salzano, A, Santilli, F, Scarpini, F, Scicali, R, Sirico, D, Suppressa, P, Talia, M, Tassone, E, Torres, D, Vazzana, N, Vecchio, C, Vidili, G, Vitale, F, Zaccone, V, Raparelli, V1, Pastori, D1, Pignataro, Sf1, Vestri, Ar2, Pignatelli, P1, Cangemi, R1, Proietti, M3, Davì, G4, Hiatt, Wr5, Lip, Gyh3, Corazza, Gr6, Perticone, F7, Violi, F8, Basili, S1, De Cristofaro, R, De Gennaro, L, Pasini, Af, Mulé, G, Di Raimondo, D, De Palma, D, De Luca, N, De Donato, Mt, Adinolfi, Le, Vincentelli, Gm, Lizzi, Em, Di Veroli, C, De Ciocchis, A, Fimognari, Fl, Fiorentino, Tv, Scarpino, Pe, De Feudis, L, Di Michele, D, De Ciantis, P, De Luca, E, De Zaiacomo, F, Sechi, La, Bruni, Aa, Pulixi, Ea, Serra, Mg, Rini, Gb, Muiesan, Ml, De Vincentis, A, Martino, Gp, Caruso, Aa, Sabbà, C, Brizzi, Mf, Del Ben, M, Romiti, Gf, Di Tanna, G, Sacchetti, Ml, Puddu, Pe, Bianchi, Pi, Buttà, C, Carrabba, Md, Colombo, Bm, De Vuono, S, Del Corso, L, Di Giosia, P, Marra, Am, Tassone, Ej, Vecchio, Cr, Zaccone, V., Pignataro, Sf, Vestri, Ar, Davì, G, Hiatt, Wr, Lip, Gyh, Corazza, Gr, Raparelli, Valeria, Pastori, Daniele, Pignataro, Serena Francesca, Vestri, Anna Rita, Pignatelli, Pasquale, Cangemi, Roberto, Proietti, Marco, Davì, Giovanni, Hiatt, William Robert, Lip, Gregory Yoke Hong, Corazza, Gino Roberto, Perticone, Francesco, Violi, Francesco, Basili, Stefania, Alessandri C., Serviddio G., Palange P., Greco E., Bruno G., Averna M., Giammanco A., Sposito P., De Cristofaro R., Carulli L., De Gennaro L., Pellegrini E. Cominacini L., Mozzini C., Pasini A.F., Sprovieri M., Spagnuolo V., Cerqua G., Cerasola G., Mulé G., Barbagallo M., Lo Sciuto S., Monteverde A., Saitta A., Lo Gullo A., Malatino L., Cilia C., Terranova V., Pisano M., Pinto A., Di Raimondo D., Tuttolomondo A., Conigliaro R., Signorelli S., De Palma D., Galderisi M., Cudemo G., Galletti F., Fazio V., De Luca N., Meccariello A., Caputo D., De Donato M. T., Iannuzi A., Bresciani A., Giunta R., Utili R., Iorio V., Adinolfi L.E., Sellitto C., Iuliano N., Bellis P., Tirelli P., Sacerdoti D., Vanni D., Iuliano L., Ciacciarelli M., Pacelli A., Palazzuoli A., Cacciafesta M., Gueli N., Lo Iacono C., Brusco S., Verrusio W., Nobili L., Tarquinio N., Pellegrini F., Vincentelli G.M., Ravallese F., Santini C., Letizia C., Petramala L., Zinnamosca L., Minisola S., Cilli M., Colangelo L., Falaschi P., Martocchia A., Pastore F., Bertazzoni G., Attalla El Halabieh E., Paradiso M., Lizzi E.M., Timmi S., Battisti P., Cerci S., Ciavolella M., Di Veroli C., Malci F., De Ciocchis A., Abate D., Castellino P., Zanoli L., Fidone F., Mannarino E., Pasqualini L., Oliverio G., Pende A., Artom N., Ricchio R., Fimognari F.L., Alletto M., Messina S., Sesti G., Arturi F., Succurro E, Fiorentino T.V., Pedace E., Scarpino P.E., Carullo G., Maio R., Sciacqua A., Frugiuele P., Spagnuolo V., Battaglia G., Atzori S., Delitala G., Angelucci E., Sestili S., Traisci G., De Feudis L., Di Michele D., Fava A., Balsano C., De Ciantis P., Desideri G., Camerota A., Mezzetti M., Gresele P., Vedovati C., Fierro T., Puccetti L., Bertolotti M., Mussi C., Boddi M., Savino A., Contri S., Degl’Innocenti G., Saller A., Fabris F., Pesavento R., Filippi L., Vedovetto V., Puato M., Fabris F., Treleani M., De Luca E., De Zaiacomo F., Giantin V., Semplicini A., Minuz P., Romano S., Fantin F., Manica A., Stockner I., Pattis P., Gutmann B., Catena C., Colussi G., Sechi L.A., Annoni G., Bruni A.A., Castagna A., Spinelli D., Miceli E., Padula D., Schinco G., Spreafico S., Secchi B., Vanoli M., Casella G., Pulixi E.A., Sansone L., Serra M.G., Longo S., Antonaci S., Belfiore A., Frualdo M., Palasciano G., Ricci L., Ventrella F., Bianco C., Santovito D., Cipollone F., Nicolai S., Salvati F., Rini G. B., Scozzari F., Muiesan M.L., Salvetti M., Bazza A., Picardi A., Vespasiani-Gentilucci U., De Vincentis A., Cosio P., Terzolo M., Madaffari B., Parasporo B., Fenoglio L., Bracco C., Melchio R., Gentili T., Salvi A., Nitti C., Gabrielli A., Martino G.P., Capucci A., Brambatti M., Sparagna A., Tirotta D., Andreozzi P., Ettorre E., Viscogliosi G., Servello A., Musumeci M., Delfino M., Giorgi A., Glorioso N., Melis G., Marras G., Matta M., Sacco A., Stellitano E., Scordo A., Russo F., Caruso A.A., Porreca E., Tana M., Ferri C., Cheli P., Portincasa P., Muscianisi G., Giordani S., Stanghellini V., Sabbà C., Mancuso G., Bartone M., Calipari D., Arcidiacono G., Bellanuova I., Ferraro M., Marigliano G., Cozzolino D., Lampitella A., Acri V., Galasso D., Mazzei F., Buratti A., Galasso S., Porta M., Brizzi M.F., Fattorini A., Sampietro F., D’Angelo A., Manfredini R., Pala M., Fabbian F., Moroni C., Valente L., Lopreiato F., Parente F., Granata M., Moia M., Braham S., Rossi M., Pesce M., Gentile A., Catozzo V., Baciarello G., Cosimati A., Ageno W., Rancan E., Guasti L., Ciccaglioni A., Negri S., Polselli M., Prisco D., Marcucci R., Ferro D., Perri L., Cangemi R., Saliola M., Del Ben M., Angelico F., Baratta F., Migliacci R., Porciello G., Corrao S. Data entry and Safety Monitoring Board: Proietti M., Raparelli V., Napoleone L., Talerico G., Amoroso D., Romiti G.F., Ruscio E., Toriello F., Sperduti N., Todisco T., Di Tanna G., Sacchetti M.L., Puddu P.E., Farcomeni A. Simi Young Internists Group: Anzaldi M., Bazzini C., Bianchi P.I., Boari B., Bracco C., Buonauro A., Buttà C., Buzzetti E., Calabria S., Capeci W., Caradio F., Carleo P., Carrabba M.D., Castorani L., Cecchetto L., Cicco S., Cimini C., Colombo B.M., De Giorgi A., De Vuono S., Del Corso L., Denegri A., Di Giosia P., Durante Mangoni E., Falsetti L., Forgione A., Giorgini P., Grassi D., Grembiale A., Hijazi D., Iamele L., Lorusso G., Marchese A., Marra A.M., Masala M., Miceli G., Montebianco Abenavoli L., Murgia G., Naccarato P., Padula D., Pattoneri P., Perego F., Pesce P., Piano S., Pinna M., Pinto D., Pretti V., Pucci G., Salinaro F., Salzano A., Santilli F., Scarpini F., Scicali R., Sirico D., Suppressa P., Talia M., Tassone E.J., Torres D., Vazzana N., Vecchio C.R., Vidili G., Vitale F., Zaccone V., Raparelli Valeria, Pastori Daniele, Pignataro Serena Francesca, Vestri Anna Rita, Pignatelli Pasquale, Cangemi Roberto, Proietti Marco, Davì Giovanni, Hiatt William Robert, Lip Gregory Yoke Hong, Corazza Gino Roberto, Perticone Francesco, Violi Francesco, Basili Stefania, Alessandri C, Serviddio G, Palange P, Greco E, Bruno G, Averna M, Giammanco A, Sposito P, De Cristofaro R, Carulli L, De Gennaro L, Pellegrini E, Cominacini L, Mozzini C, Pasini AF, Sprovieri M, Spagnuolo V, Cerqua G, Cerasola G, Mulé G, Barbagallo M, Lo Sciuto S, Monteverde A, Saitta A, Lo Gullo A, Malatino L, Cilia C, Terranova V, Pisano M, Pinto A, Di Raimondo D, Tuttolomondo A, Conigliaro R, Signorelli S, De Palma D, Galderisi M, Cudemo G, Galletti F, Fazio V, De Luca N, Meccariello A, Caputo D, De Donato MT, Iannuzi A, Bresciani A, Giunta R, Utili R, Iorio V, Adinolfi LE, Sellitto C, Iuliano N, Bellis P, Tirelli P, Sacerdoti D, Vanni D, Iuliano L, Ciacciarelli M, Pacelli A, Palazzuoli A, Cacciafesta M, Gueli N, Lo Iacono C, Brusco S, Verrusio W, Nobili L, Tarquinio N, Pellegrini F, Vincentelli GM, Ravallese F, Santini C, Letizia C, Petramala L, Zinnamosca L, Minisola S, Cilli M, Colangelo L, Falaschi P, Martocchia A, Pastore F, Bertazzoni G, Attalla El Halabieh E, Paradiso M, Lizzi EM, Timmi S, Battisti P, Cerci S, Ciavolella M, Di Veroli C, Malci F, De Ciocchis A, Abate D, Castellino P, Zanoli L, Fidone F, Mannarino E, Pasqualini L, Oliverio G, Pende A, Artom N, Ricchio R, Fimognari FL, Alletto M, Messina S, Sesti G, Arturi F, Succurro E, Fiorentino TV, Pedace E, Scarpino PE, Carullo G, Maio R, Sciacqua A, Frugiuele P, Battaglia G, Atzori S, Delitala G, Angelucci E, Sestili S, Traisci G, De Feudis L, Di Michele D, Fava A, Balsano C, De Ciantis P, Desideri G, Camerota A, Mezzetti M, Gresele P, Vedovati C, Fierro T, Puccetti L, Bertolotti M, Mussi C, Boddi M, Savino A, Contri S, Degl’Innocenti G, Saller A, Fabris F, Pesavento R, Filippi L, Vedovetto V, Puato M, Treleani M, De Luca E, De Zaiacomo F, Giantin V, Semplicini A, Minuz P, Romano S, Fantin F, Manica A, Stockner I, Pattis P, Gutmann B, Catena C, Colussi G, Sechi LA, Annoni G, Bruni AA, Castagna A, Spinelli D, Miceli E, Padula D, Schinco G, Spreafico S, Secchi B, Vanoli M, Casella G, Pulixi EA, Sansone L, Serra MG, Longo S, Antonaci S, Belfiore A, Frualdo M, Palasciano G, Ricci L, Ventrella F, Bianco C, Santovito D, Cipollone F, Nicolai S, Salvati F, Rini GB, Scozzari F, Muiesan ML, Salvetti M, Bazza A, Picardi A, Vespasiani-Gentilucci U, De Vincentis A, Cosio P, Terzolo M, Madaffari B, Parasporo B, Fenoglio L, Bracco C, Melchio R, Gentili T, Salvi A, Nitti C, Gabrielli A, Martino GP, Capucci A, Brambatti M, Sparagna A, Tirotta D, Andreozzi P, Ettorre E, Viscogliosi G, Servello A, Musumeci M, Delfino M, Giorgi A, Glorioso N, Melis G, Marras G, Matta M, Sacco A, Stellitano E, Scordo A, Russo F, Caruso AA, Porreca E, Tana M, Ferri C, Cheli P, Portincasa P, Muscianisi G, Giordani S, Stanghellini V, Sabbà C, Mancuso G, Bartone M, Calipari D, Arcidiacono G, Bellanuova I, Ferraro M, Marigliano G, Cozzolino D, Lampitella A, Acri V, Galasso D, Mazzei F, Buratti A, Galasso S, Porta M, Brizzi MF, Fattorini A, Sampietro F, D’Angelo A, Manfredini R, Pala M, Fabbian F, Moroni C, Valente L, Lopreiato F, Parente F, Granata M, Moia M, Braham S, Rossi M, Pesce M, Gentile A, Catozzo V, Baciarello G, Cosimati A, Ageno W, Rancan E, Guasti L, Ciccaglioni A, Negri S, Polselli M, Prisco D, Marcucci R, Ferro D, Perri L, Cangemi R, Saliola M, Del Ben M, Angelico F, Baratta F, Migliacci R, Porciello G, Corrao S, Proietti M, Raparelli V, Napoleone L, Talerico G, Amoroso D, Romiti GF, Ruscio E, Toriello F, Sperduti N, Todisco T, Di Tanna G, Sacchetti ML, Puddu PE, Farcomeni A, Anzaldi M, Bazzini C, Bianchi PI, Boari B, Buonauro A, Buttà C, Buzzetti E, Calabria S, Capeci W, Caradio F, Carleo P, Carrabba MD, Castorani L, Cecchetto L, Cicco S, Cimini C, Colombo BM, De Giorgi A, De Vuono S, Del Corso L, Denegri A, Di Giosia P, Durante Mangoni E, Falsetti L, Forgione A, Giorgini P, Grassi D, Grembiale A, Hijazi D, Iamele L, Lorusso G, Marchese A, Marra AM, Masala M, Miceli G, Montebianco Abenavoli L, Murgia G, Naccarato P, Pattoneri P, Perego F, Pesce P, Piano S, Pinna M, Pinto D, Pretti V, Pucci G, Salinaro F, Salzano A, Santilli F, Scarpini F, Scicali R, Sirico D, Suppressa P, Talia M, Tassone EJ, Torres D, Vazzana N, Vecchio CR, Vidili G, Vitale F, and Zaccone V
- Subjects
Male ,Settore MED/09 - Medicina Interna ,030204 cardiovascular system & hematology ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Risk Factors ,Major cardiovascular event ,Cause of Death ,Risk of mortality ,Prevalence ,Medicine ,030212 general & internal medicine ,Prospective Studies ,Registries ,Prospective cohort study ,Stroke ,Cause of death ,COPD ,Chronic obstructive pulmonary disease ,Incidence ,Hazard ratio ,Atrial fibrillation ,Cardiovascular mortality ,Major cardiovascular events ,Aged ,Atrial Fibrillation ,Cardiovascular Diseases ,Endpoint Determination ,Female ,Follow-Up Studies ,Humans ,Italy ,Predictive Value of Tests ,Internal Medicine ,Emergency Medicine ,Atrial fibrillation, Cardiovascular mortality, Chronic obstructive pulmonary disease, Major cardiovascular events ,Cardiology ,Settore SECS-S/01 - Statistica ,medicine.medical_specialty ,Chronic Obstructive ,Socio-culturale ,Pulmonary Disease ,03 medical and health sciences ,Internal medicine ,cardiovascular diseases ,business.industry ,medicine.disease ,business ,Mace - Abstract
Chronic obstructive pulmonary disease (COPD) increases the risk of mortality in non-valvular atrial fibrillation (NVAF) patients. Data on the relationship of COPD to major cardiovascular events (MACE) in AF have not been defined. The aim of the study is to assess the predictive value of COPD on incident MACE in NVAF patients over a 3-year follow-up. In the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study (ARAPACIS) cohort, we evaluate the impact of COPD on the following clinical endpoints: MACE (including vascular death, fatal/non-fatal MI and stroke/TIA), cardiovascular (CV) death and all-cause mortality. Among 2027 NVAF patients, patients with COPD (9%) are more commonly male, elderly and at higher thromboembolic risk. During a median 36.0months follow-up, 186 patients experienced MACE: vascular death (n = 72), MI (n = 57), stroke/TIA (n = 57). All major outcomes (including stroke/TIA, MI, vascular death, and all-cause death) are centrally adjudicated. Kaplan–Meier curves show that NVAF patients with COPD are at higher risk for MACE (p < 0.001), CV death (p < 0.001) and all-cause death (p < 0.001). On Cox proportional hazard analysis, COPD is an independent predictor of MACE (Hazard ratio [HR] 1.77, 95% Confidence Intervals [CI] 1.20–2.61; p = 0.004), CV death (HR 2.73, 95% CI 1.76–4.23; p < 0.0001) and all-cause death (HR 2.16, 95% CI 1.48–3.16; p < 0.0001). COPD is an independent predictor of MACE, CV death and all-cause death during a long-term follow-up of NVAF patients.
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- 2018
9. Diagnostic Delay of Celiac Disease in Childhood.
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Bianchi PI, Lenti MV, Petrucci C, Gambini G, Aronico N, Varallo M, Rossi CM, Pozzi E, Groppali E, Siccardo F, Franchino G, Zuccotti GV, Di Leo G, Zanchi C, Cristofori F, Francavilla R, Aloi M, Gagliostro G, Montuori M, Romaggioli S, Strisciuglio C, Crocco M, Zampatti N, Calvi A, Auricchio R, De Giacomo C, Caimmi SME, Carraro C, Staiano A, Cenni S, Congia M, Schirru E, Ferretti F, Ciacci C, Vecchione N, Latorre MA, Resuli S, Moltisanti GC, Abruzzese GM, Quadrelli A, Saglio S, Canu P, Ruggeri D, De Silvestri A, Klersy C, Marseglia GL, Corazza GR, and Di Sabatino A
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- Child, Female, Humans, Male, Abdominal Pain, Cross-Sectional Studies, Delayed Diagnosis, Retrospective Studies, Child, Preschool, Celiac Disease diagnosis, Celiac Disease epidemiology, Gastroesophageal Reflux
- Abstract
Importance: The extent and factors associated with risk of diagnostic delay in pediatric celiac disease (CD) are poorly understood., Objectives: To investigate the diagnostic delay of CD in childhood, and to assess factors associated with this delay., Design, Setting, and Participants: Multicenter, retrospective, cross-sectional study (2010-2019) of pediatric (aged 0-18 years) patients with CD from 13 pediatric tertiary referral centers in Italy. Data were analyzed from January to June 2023., Main Outcomes and Measures: The overall diagnostic delay (ie, the time lapse occurring from the first symptoms or clinical data indicative of CD and the definitive diagnosis), further split into preconsultation and postconsultation diagnostic delay, were described. Univariable and multivariable linear regression models for factors associated with diagnostic delay were fitted. Factors associated with extreme diagnostic delay (ie, 1.5 × 75th percentile) and misdiagnosis were assessed., Results: A total of 3171 patients with CD were included. The mean (SD) age was 6.2 (3.9) years; 2010 patients (63.4%) were female; and 10 patients (0.3%) were Asian, 41 (1.3%) were Northern African, and 3115 (98.3%) were White. The median (IQR) overall diagnostic delay was 5 (2-11) months, and preconsultation and postconsultation diagnostic delay were 2 (0-6) months and 1 (0-3) month, respectively. The median (IQR) extreme overall diagnostic delay (586 cases [18.5%]) was 11 (5-131) months, and the preconsultation and postconsultation delays were 6 (2-120) and 3 (1-131) months, respectively. Patients who had a first diagnosis when aged less than 3 years (650 patients [20.5%]) showed a shorter diagnostic delay, both overall (median [IQR], 4 [1-7] months for patients aged less than 3 years vs 5 [2-12] months for others) and postconsultation (median [IQR], 1 [0-2] month for patients aged less than 3 years vs 2 [0-4] months for others). A shorter delay was registered in male patients, both overall (median [IQR], 4 [1-10] months for male patients vs 5 [2-12] months for female patients) and preconsultation (median [IQR], 1 [0-6] month for male patients vs 2 [0-6] months for female patients). Family history of CD was associated with lower preconsultation delay (odds ratio [OR], 0.59; 95% CI, 0.47-0.74) and lower overall extreme diagnostic delay (OR, 0.75; 95% CI, 0.56-0.99). Neurological symptoms (78 patients [21.5%]; OR, 1.35; 95% CI, 1.03-1.78), gastroesophageal reflux (9 patients [28.1%]; OR, 1.87; 95% CI, 1.02-3.42), and failure to thrive (215 patients [22.6%]; OR, 1.62; 95% CI, 1.31-2.00) showed a more frequent extreme diagnostic delay. A previous misdiagnosis (124 patients [4.0%]) was more frequently associated with gastroesophageal reflux disease, diarrhea, bloating, abdominal pain, constipation, fatigue, osteopenia, and villous atrophy (Marsh 3 classification)., Conclusions and Relevance: In this cross-sectional study of pediatric CD, the diagnostic delay was rather short. Some factors associated with risk for longer diagnostic delay and misdiagnosis emerged, and these should be addressed in future studies.
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- 2024
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10. Diagnostic delay in adult coeliac disease: An Italian multicentre study.
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Lenti MV, Aronico N, Bianchi PI, D'Agate CC, Neri M, Volta U, Mumolo MG, Astegiano M, Calabrò AS, Zingone F, Latella G, Di Sario A, Carroccio A, Ciacci C, Luzza F, Bagnato C, Fantini MC, Elli L, Cammarota G, Gasbarrini A, Portincasa P, Latorre MA, Petrucci C, Quatraccioni C, Iannelli C, Vecchione N, Rossi CM, Broglio G, Ianiro G, Marsilio I, Bibbò S, Marinoni B, Tomaselli D, Abenavoli L, Pilia R, Santacroce G, Lynch E, Carrieri A, Mansueto P, Gabba M, Alunno G, Rossi C, Onnis F, Efthymakis K, Cesaro N, Vernero M, Baiano Svizzero F, Semeraro FP, Silano M, Vanoli A, Klersy C, Corazza GR, and Di Sabatino A
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- Humans, Adult, Middle Aged, Delayed Diagnosis, Retrospective Studies, Italy epidemiology, Odds Ratio, Celiac Disease diagnosis, Celiac Disease epidemiology
- Abstract
Background: There are few data regarding the diagnostic delay and its predisposing factors in coeliac disease (CD)., Aims: To investigate the overall, the patient-dependant, and the physician-dependant diagnostic delays in CD., Methods: CD adult patients were retrospectively enroled at 19 Italian CD outpatient clinics (2011-2021). Overall, patient-dependant, and physician-dependant diagnostic delays were assessed. Extreme diagnostic, i.e., lying above the third quartile of our population, was also analysed. Multivariable regression models for factors affecting the delay were fitted., Results: Overall, 2362 CD patients (median age at diagnosis 38 years, IQR 27-46; M:F ratio=1:3) were included. The median overall diagnostic delay was 8 months (IQR 5-14), while patient- and physician-dependant delays were 3 (IQR 2-6) and 4 (IQR 2-6) months, respectively. Previous misdiagnosis was associated with greater physician-dependant (1.076, p = 0.005) and overall (0.659, p = 0.001) diagnostic delays. Neurological symptoms (odds ratio 2.311, p = 0.005) and a previous misdiagnosis (coefficient 9.807, p = 0.000) were associated with a greater extreme physician-dependant delay. Gastrointestinal symptoms (OR 1.880, p = 0.004), neurological symptoms (OR 2.313, p = 0.042), and previous misdiagnosis (OR 4.265, p = 0.000) were associated with increased extreme overall diagnostic delay., Conclusion: We identified some factors that hamper CD diagnosis. A proper screening strategy for CD should be implemented., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
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- 2023
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11. Clinical and Histopathological Features of an Italian Monocentric Series of Primary Small Bowel T-Cell Lymphomas.
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Lucioni M, Fraticelli S, Santacroce G, Bonometti A, Aronico N, Sciarra R, Lenti MV, Bianchi PI, Neri G, Feltri M, Neri B, Ferrario G, Riboni R, Corazza GR, Vanoli A, Arcaini L, Paulli M, and Di Sabatino A
- Abstract
The gastrointestinal (GI) tract is the most common extranodal site of occurrence of non-Hodgkin lymphomas. Most GI lymphomas are of B-cell lineage, while T-cell lymphomas are less frequent. The aim of our retrospective study was to depict the clinical-pathological profile of a series of patients affected by intestinal T-cell lymphomas (ITCL) and possibly define hallmarks of these neoplasms. A total of 28 patients were included: 17 enteropathy-associated T-cell lymphomas (EATL), 5 monomorphic epitheliotropic T-cell lymphomas (MEITL), 3 indolent T-cell lymphoproliferative disorders of the gastrointestinal tract (ITCLDGT), and 3 intestinal T-cell lymphomas not otherwise specified (ITCL-NOS). Celiac disease (CD) was diagnosed in around 70% of cases. Diagnosis of EATL showed a significant correlation with CD30 expression, whereas MEITL with angiotropism and CD56 positivity. ITCLDGT cases showed plasma cells infiltration. Peripheral lymphocytosis, the absence of a previous diagnosis of CD, an advanced Lugano clinical stage, and the histological subtype ITCL-NOS were significantly associated with worse survival at multivariate analysis. Our findings about the epidemiological, clinical, and histopathological features of ITCL were in line with the current knowledge. Reliable prognostic tools for these neoplasms are still lacking but according to our results lymphocytosis, diagnosis of CD, Lugano clinical stage, and histological subtype should be considered for patient stratification.
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- 2023
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12. Seronegative autoimmune diseases: A challenging diagnosis.
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Lenti MV, Rossi CM, Melazzini F, Gastaldi M, Bugatti S, Rotondi M, Bianchi PI, Gentile A, Chiovato L, Montecucco C, Corazza GR, and Di Sabatino A
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- Autoantibodies, Humans, Arthritis, Rheumatoid, Autoimmune Diseases, Hashimoto Disease, Myasthenia Gravis complications, Sjogren's Syndrome
- Abstract
Autoimmune diseases (AID) are increasingly prevalent conditions which comprise more than 100 distinct clinical entities that are responsible for a great disease burden worldwide. The early recognition of these diseases is key for preventing their complications and for tailoring proper management. In most cases, autoantibodies, regardless of their potential pathogenetic role, can be detected in the serum of patients with AID, helping clinicians in making a definitive diagnosis and allowing screening strategies for early -and sometimes pre-clinical- diagnosis. Despite their undoubted crucial role, in a minority of cases, patients with AID may not show any autoantibody, a condition that is referred to as seronegative AID. Suboptimal accuracy of the available laboratory tests, antibody absorption, immunosuppressive therapy, immunodeficiencies, antigen exhaustion, and immunosenescence are the main possible determinants of seronegative AID. Indeed, in seronegative AID, the diagnosis is more challenging and must rely on clinical features and on other available tests, often including histopathological evaluation and radiological diagnostic tests. In this review, we critically dissect, in a narrative fashion, the possible causes of seronegativity, as well as the diagnostic and management implications, in several AID including autoimmune gastritis, celiac disease, autoimmune liver disease, rheumatoid arthritis, autoimmune encephalitis, myasthenia gravis, Sjögren's syndrome, antiphospholipid syndrome, and autoimmune thyroid diseases., (Copyright © 2022 Elsevier B.V. All rights reserved.)
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- 2022
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13. Clinical and gastro-duodenal histopathological features of enteropathy due to angiotensin II receptor blockers.
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Costetti M, Schiepatti A, Fraticelli S, Costa S, Maimaris S, Lenti MV, Villani L, Bianchi PI, Di Sabatino A, Corazza GR, Vanoli A, and Biagi F
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- Adult, Aged, Angiotensin Receptor Antagonists adverse effects, Angiotensin Receptor Antagonists pharmacology, Case-Control Studies, Celiac Disease drug therapy, Duodenum diagnostic imaging, Female, Gastric Mucosa diagnostic imaging, Gastroscopy, Humans, Male, Middle Aged, Retrospective Studies, Duodenum pathology, Enteritis chemically induced, Eosinophilia chemically induced, Gastric Mucosa pathology, Gastritis chemically induced
- Abstract
Background: Clinical elements differentiating enteropathy due to angiotensin II-receptor-blockers (ARBs-E) from coeliac disease (CD) are poorly defined. The histopathological features on duodenal and gastric biopsies in these patients still need to be investigated., Aims: To describe the clinical phenotype of ARBs-E in comparison to CD, and the histological findings of gastric and duodenal biopsies in ARBs-E., Methods: Clinical data of patients with ARBs-E and CD diagnosed between 2013 and 2020 were retrospectively reviewed. Baseline presenting symptoms and demographics were compared (Fisher's exact test and t-test). Gastric and duodenal histology in ARBs-E were revised by two independent pathologists., Results: 14 ARBs-E and 112 CD patients were enroled. Weight loss (p < 0.01), acute onset of diarrhoea (p < 0.01), hospitalization (p < 0.01), and older age at diagnosis (p < 0.01) were more common in ARBs-E. Duodenal histology in ARBs-E showed intraepithelial lymphocytosis in 71%, increased mucosal eosinophilic count in 57%, with preserved neuroendocrine, Paneth and goblet cells in all patients. Gastric histologic lesions at baseline, including lymphocytic gastritis, eosinophilic gastritis, chronic active gastritis, and metaplastic atrophic gastritis patterns were observed in 73% of patients, without Helicobacter pylori infection., Conclusions: ARBs-E showed a severe clinical phenotype, often requiring hospital admission. Gastric involvement at diagnosis is very common, and this could further support this diagnosis., Competing Interests: Declaration of Competing Interest None to declare., (Copyright © 2021. Published by Elsevier Ltd.)
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- 2021
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14. Dental enamel defects in adult coeliac disease: prevalence and correlation with symptoms and age at diagnosis.
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Trotta L, Biagi F, Bianchi PI, Marchese A, Vattiato C, Balduzzi D, Collesano V, and Corazza GR
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- Adult, Female, Humans, Male, Middle Aged, Severity of Illness Index, Tooth Diseases pathology, Young Adult, Celiac Disease complications, Dental Enamel pathology, Tooth Diseases etiology
- Abstract
Background: Coeliac disease is a condition characterized by a wide spectrum of clinical manifestations. Any organ can be affected and, among others, dental enamel defects have been described. Our aims were to study the prevalence of dental enamel defects in adults with coeliac disease and to investigate a correlation between the grade of teeth lesion and clinical parameters present at the time of diagnosis of coeliac disease., Methods: A dental examination was performed in 54 coeliac disease patients (41 F, mean age 37 ± 13 years, mean age at diagnosis 31 ± 14 years). Symptoms leading to diagnosis were diarrhoea/weight loss (32 pts.), anaemia (19 pts.), familiarity (3 pts.); none of the patients was diagnosed because of enamel defects. At the time of evaluation, they were all on a gluten-free diet. Enamel defects were classified from grade 0 to 4 according to its severity., Results: Enamel defects were observed in 46/54 patients (85.2%): grade 1 defects were seen in 18 patients (33.3%) grade 2 in 16 (29.6%), grade 3 in 8 (14.8%), and grade 4 in 4 (7.4%). We also observed that grades 3 and 4 were more frequent in patients diagnosed with classical rather than non-classical coeliac disease (10/32 vs. 2/20). However, this was not statistically significant., Conclusion: This study confirms that enamel defects are common in adult coeliac disease. Observation of enamel defects is an opportunity to diagnose coeliac disease., (Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
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- 2013
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15. IgA anti-epidermal transglutaminase autoantibodies: a sensible and sensitive marker for diagnosis of dermatitis herpetiformis in adult patients.
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Borroni G, Biagi F, Ciocca O, Vassallo C, Carugno A, Cananzi R, Campanella J, Bianchi PI, Brazzelli V, and Corazza GR
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- Adolescent, Adult, Aged, Aged, 80 and over, Biomarkers blood, Celiac Disease blood, Celiac Disease immunology, Dermatitis Herpetiformis immunology, Epidermis immunology, Female, Humans, Male, Middle Aged, Sensitivity and Specificity, Young Adult, Autoantibodies blood, Autoantibodies immunology, Dermatitis Herpetiformis blood, Dermatitis Herpetiformis diagnosis, Immunoglobulin A immunology, Transglutaminases immunology
- Abstract
Background: Dermatitis herpetiformis (DH) is a rare gluten-sensitive blistering itchy skin disease, strictly related to coeliac disease (CD). Direct immunofluorescence, demonstrating IgA granular deposits localized either in the dermal papillae or along the dermo-epidermal junction, is currently the gold standard for diagnosis of DH. It has been shown that DH immunocomplexes contain epidermal transglutaminase (eTG) and that sera from patients with DH contain antibodies specifically directed against eTG., Objectives: We studied the usefulness of serum eTG antibodies in discriminating between DH, CD and other gastrointestinal and dermatologic diseases., Methods: eTG antibodies were tested in 308 adult patients' sera: 44 patients with untreated dermatitis herpetiformis (UDH), 99 patients with untreated coeliac disease (UCD), 70 dermatological controls and 95 gastrointestinal controls., Results: In UDH eTG antibody levels were significantly higher than in DH patients on gluten-free diet, UCD, gastrointestinal controls and dermatological controls. In UCD eTG antibodies strongly correlated with tissue transglutaminase (tTG) antibodies, whereas in UDH no significant correlation was observed., Conclusion: Serum IgA eTG antibody determination can efficiently distinguish UDH from other dermatological itchy diseases and is highly sensitive to gluten-free diet., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)
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- 2013
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16. Prevalence and natural history of potential celiac disease in adult patients.
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Biagi F, Trotta L, Alfano C, Balduzzi D, Staffieri V, Bianchi PI, Marchese A, Vattiato C, Zilli A, Luinetti O, Gobbi P, and Corazza GR
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- Adult, Case-Control Studies, Celiac Disease diagnosis, Celiac Disease diet therapy, Celiac Disease pathology, Diet, Gluten-Free, Female, Follow-Up Studies, Humans, Italy epidemiology, Male, Middle Aged, Prevalence, Retrospective Studies, Young Adult, Asymptomatic Diseases epidemiology, Celiac Disease epidemiology, Disease Progression
- Abstract
Objective: Potential celiac disease (PCD) is a form of CD characterized by positive endomysial/tissue transglutaminase antibodies and a preserved duodenal mucosa despite a gluten-containing diet (GCD); it can evolve into flat, active CD. This evolution is, however, not certain. Our aim was to retrospectively study the prevalence and the natural history of adult patients with PCD., Methods: The clinical notes of all 47 patients with PCD attending our clinic between September 1999 and October 2011 were retrospectively reevaluated. To study their clinical features, patients with active CD, randomly selected and matched for sex and date of birth, served as controls. Symptoms, associated diseases, familiarity, and laboratory data at diagnosis were compared., Results: Prevalence of PCD among all celiac patients directly diagnosed in our center was 42/187, (1/4.4, 18.3%, 95% confidence interval (CI) 13.3-23.4%). Age at diagnosis, laboratory data, prevalence of symptoms, associated diseases, and familiarity for CD did not differ between patients with PCD and those with active CD. Some patients with PCD maintained a normal duodenal mucosa for many years and their symptoms spontaneously improved despite maintaining a GCD., Conclusions: PCD is not a rare form of CD. Having found no difference at all in age at diagnosis and clinical features between PCD and active CD could suggest that PCD is not a prodrome of CD but is a separate entity that can only subsequently evolve into active CD.
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- 2013
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17. Quality of life in coeliac patients: Italian validation of a coeliac questionnaire.
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Marchese A, Klersy C, Biagi F, Balduzzi D, Bianchi PI, Trotta L, Vattiato C, Zilli A, Rademacher J, Andrealli A, Astegiano M, Michelini I, Häuser W, and Corazza GR
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- Adult, Cultural Characteristics, Female, Humans, Language, Male, Translations, Celiac Disease diagnosis, Quality of Life, Surveys and Questionnaires
- Abstract
Background: Coeliac disease (CD) is a chronic condition requiring a gluten-free diet, which is a very demanding diet to maintain on a life-long basis. For this reason it is a condition that can have serious repercussions on the quality of life (QOL). Therefore the need to elaborate a questionnaire on QOL specifically for patients with CD (CDQ): its original language is German, and the translation/validation process represents a considerable challenge involving not only a translation into Italian but also an adaptation to the country's specific cultural differences., Methods: The questionnaire has been translated according to a "German → Italian → Italian → German" algorithm with reconciliation of the differences. Scores for CDQ are computed overall and over four areas of four items each: emotion, gastrointestinal symptoms, gastrointestinal worries, social problems., Results: CDQ was administered to 171 coeliacs (F 132, mean age 38 yrs ± 14). Completeness was optimal. Item internal consistency was satisfied for 100% and 97% of patients for the specific and generic part, respectively. Cronbach's α coefficient was 0.7 for all scales. The general CDQ was higher in patients reporting subjective well-being (discriminant validity)., Conclusions: The Italian translation of CDQ sounds natural, is easy to understand and reduces possible cultural biases to a minimum. A field test gave results comparable to the original validation, supporting the use of CDQ in cross-national surveys., (Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
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- 2013
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18. A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life.
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Biagi F, Bianchi PI, Marchese A, Trotta L, Vattiato C, Balduzzi D, Brusco G, Andrealli A, Cisarò F, Astegiano M, Pellegrino S, Magazzù G, Klersy C, and Corazza GR
- Subjects
- Adult, Celiac Disease blood, Cohort Studies, Female, Humans, Male, Middle Aged, Models, Biological, Reproducibility of Results, Surveys and Questionnaires, Young Adult, Antibodies blood, Celiac Disease diet therapy, Celiac Disease pathology, Diet, Gluten-Free, Intestines pathology
- Abstract
A dietary interview performed by expert personnel is the best method to check whether patients with coeliac disease follow a strict gluten-free diet (GFD). We previously developed a score based on four fast and simple questions that can be administered even by non-expert personnel. The aim of the present study is to verify the reliability of our questionnaire in a new cohort of patients. The questionnaire has a five-level score. From March 2008 to January 2011, the questionnaire was administered to 141 coeliac patients on a GFD, who were undergoing re-evaluation. The score obtained was compared with persistence of both villous atrophy and endomysial antibodies (EMA). The rate of lower scores was higher among the patients with persistence of either villous atrophy (Fisher's exact, P < 0·001; test for trend, P < 0·001) or positive EMA (Fisher's exact, P = 0·001; test for trend, P = 0·018). Given that the coeliac patients have been well instructed on what a GFD means and on how to follow it, our questionnaire is a reliable and simple method to verify compliance to a GFD.
- Published
- 2012
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19. Cytokine genetic profile in Whipple's disease.
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Biagi F, Badulli C, Feurle GE, Müller C, Moos V, Schneider T, Marth T, Mytilineos J, Garlaschelli F, Marchese A, Trotta L, Bianchi PI, Di Stefano M, Cremaschi AL, De Silvestri A, Salvaneschi L, Martinetti M, and Corazza GR
- Subjects
- Adolescent, Adult, Aged, Female, Genotype, Germany, Humans, Italy, Male, Middle Aged, T-Lymphocytes, Regulatory immunology, Th1 Cells immunology, Th17 Cells immunology, Th2 Cells immunology, Young Adult, Cytokines genetics, Polymorphism, Genetic, Tropheryma immunology, Whipple Disease genetics
- Abstract
Whipple's disease (WD) is a very rare chronic systemic condition characterised by a Th2/T regulatory (Treg) dysregulated immune response versus Tropheryma whipplei, a bacterium widely diffuse in the environment. To investigate whether this Th2/Treg polarised response has a genetic background, we investigated the Th1, Th2, Th17 and Treg cytokine genetic profile of 133 patients with WD. Thanks to the European Consortium on WD (QLG1-CT-2002-01049), the polymorphism of 13 cytokine genes was analysed in 111 German and 22 Italian patients using the polymerase chain reaction with sequence-specific primers (PCR-SSP) technique. The frequencies of the genotypes, haplotypes and functional phenotypes were compared with those obtained in 201 German and 140 Italian controls. Clinical heterogeneity was also considered. Functionally, WD patients may be considered as low producers of TGF-β1, having an increased frequency of the genotype TGF-β1+869C/C,+915C/C [12.3 % vs. 3.81 %, odds ratio (OR) = 4.131, p = 0.0002] and high secretors of IL-4, carrying the genotype IL-4-590T/T (5.34 % vs. 1.17 %, OR = 5.09, p = 0.0096). No significant association was found between cytokine polymorphism and clinical variability. Analogously to the recent cellular findings of a Th2/Treg polarised response, we showed that the cytokine genetic profile of WD patients is skewed toward a Th2 and Treg response. This was similar in both German and Italian populations. However, the significant deviations versus the controls are poorer than that expected on the basis of these recent cellular findings.
- Published
- 2012
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20. Previous immunosuppressive therapy is a risk factor for immune reconstitution inflammatory syndrome in Whipple's disease.
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Biagi F, Trotta L, Di Stefano M, Balduzzi D, Marchese A, Vattiato C, Bianchi PI, Fenollar F, and Corazza GR
- Subjects
- Female, Humans, Immunosuppressive Agents therapeutic use, Male, Polymerase Chain Reaction, Retrospective Studies, Risk Factors, Whipple Disease drug therapy, Immune Reconstitution Inflammatory Syndrome etiology, Immunosuppressive Agents adverse effects, Tropheryma isolation & purification, Whipple Disease complications
- Abstract
Introduction: Whipple's disease is a rare chronic infection caused by Tropheryma whipplei. Although most patients respond to antibiotics, in some of them the start of the treatment is followed by recurrence of inflammation. Since polymerase chain reaction is negative for Tropheryma whipplei, this reinflammation cannot be a relapse of Whipple's disease itself. Very recently, it has been recognised as a complication of Whipple's disease and defined immune reconstitution inflammatory syndrome (IRIS). Our aim is to study the prevalence and the clinical features of IRIS in Italian patients with Whipple's disease., Methods: Evidence of IRIS was retrospectively revaluated in the clinical notes of 22 patients with Whipple's disease. Patients with no evidence of IRIS served as controls for the clinical findings., Results: Recurrence of arthralgia and/or fever allowed a diagnosis of IRIS in 5/22 patients. One patient died. Previous immunosuppressive therapy was found in all patients with IRIS but only in 7/17 controls (Fisher test, p=0.039). Age at diagnosis and diagnostic delay were higher in patients with IRIS compared to controls. However, statistical significance was not reached., Conclusions: IRIS is a frequent complication of Whipple's disease and it can be fatal. The risk of IRIS is greatly increased in patients previously treated with immunosuppressive therapy., (Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2012
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21. TCRβ clonality improves diagnostic yield of TCRγ clonality in refractory celiac disease.
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Perfetti V, Brunetti L, Biagi F, Ciccocioppo R, Bianchi PI, and Corazza GR
- Subjects
- Adolescent, Adult, Biopsy, Celiac Disease immunology, Celiac Disease pathology, Duodenum metabolism, Duodenum pathology, Female, Humans, Lymphoma, T-Cell immunology, Lymphoma, T-Cell pathology, Male, Middle Aged, Polymerase Chain Reaction methods, Predictive Value of Tests, Receptors, Antigen, T-Cell, alpha-beta genetics, Receptors, Antigen, T-Cell, alpha-beta metabolism, Receptors, Antigen, T-Cell, gamma-delta genetics, Receptors, Antigen, T-Cell, gamma-delta metabolism, Sequence Analysis, DNA, Young Adult, Celiac Disease complications, Celiac Disease diagnosis, Duodenum immunology, Gene Rearrangement, beta-Chain T-Cell Antigen Receptor genetics, Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor genetics, Lymphoma, T-Cell complications, Lymphoma, T-Cell diagnosis
- Abstract
Background: Refractory celiac disease (RCD) is a preneoplastic condition as many patients develop an enteropathy-type T-cell lymphoma, a mature T-cell receptor α-β lymphoma arising in the gut with an ominous outcome. Recently, research focused on a population of intraepithelial intestinal lymphocytes expressing the same lymphoma T-cell receptor variable region (V)γ, as shown by polymerase chain reaction (PCR) analysis and sequencing. Meanwhile, the Biomedicine and Health-2 Concerted Action has made available standardized, highly specific, and sensitive PCR assays not only for Vγ but also for Vβ., Goals: We verified whether analyzing both rearrangements in duodenal biopsies from RCD patients increases the diagnostic accuracy of this method., Study: Duodenal biopsies were analyzed from 15 RCD patients, 21 negative controls, and 2 positive controls (enteropathy-type T-cell lymphoma complicating celiac disease). Multiplex clonality analyses were performed according to the Biomedicine and Health-2 protocols. PCR products were cloned and sequenced., Results: Monoclonal rearrangements were found in 5/15 samples from patients with RCD (both rearrangements in 2 cases, Vβ only in 2, and only 1 solitary Vγ clonality). Monoclonality was found in 4/8 of the RCD patients who subsequently died, whereas only 1/7 of the patients still alive presented a monoclonal rearrangement. Positive controls revealed both monoclonal rearrangements; rearrangements were not detected in 20 of 21 negative controls. Sequencing of the amplified fragments confirmed the results., Conclusions: The combined analysis of both rearrangements allowed recognition of monoclonal populations in otherwise negative patients, with detection rates from 20% (Vγ only) to 33% (Vγ and Vβ), thus raising the likelihood of early identification of RCD patients at high risk of death.
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- 2012
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22. Histologic evidence for mild lesions in coeliac disease: the challenge is open.
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Bianchi PI, Biagi F, and Corazza GR
- Subjects
- Female, Humans, Male, Celiac Disease blood, Intestinal Mucosa pathology
- Published
- 2012
- Full Text
- View/download PDF
23. Antibodies to wheat high-molecular-weight glutenin subunits in patients with celiac disease.
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Ellis HJ, Lozano-Sanchez P, Bermudo Redondo C, Šuligoj T, Biagi F, Bianchi PI, Corazza GR, De Silvestri A, Bravi E, Katakis I, O'Sullivan CK, and Ciclitira PJ
- Subjects
- Adaptive Immunity, Amino Acid Sequence, Antibodies blood, Antibodies immunology, Antibody Specificity, Celiac Disease blood, Gliadin chemistry, Glutens chemistry, Humans, Immunoglobulin A blood, Immunoglobulin A immunology, Molecular Sequence Data, Molecular Weight, Protein Subunits chemistry, Protein Subunits immunology, Recombinant Proteins chemistry, Recombinant Proteins metabolism, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, Transglutaminases metabolism, Triticum chemistry, Celiac Disease diagnosis, Celiac Disease immunology, Gliadin immunology, Glutens immunology, Triticum immunology
- Abstract
Background: Wheat gluten comprises gliadins and glutenins. The high-molecular-weight (HMW) glutenin subunits (GS)-1Dy10 are toxic for patients with celiac disease (CD). This study aimed to assess whether CD patients mount a serological response to HMW-GS-1Dy10., Methods: Recombinant HMW-GS-1Dy10 was deamidated using human recombinant tissue transglutaminase. MALDI-TOF was performed to compare the level of deamidation of glutamine residues between material before and after treatment. Enzyme-linked immunosorbent assays were developed. Sera from patients with untreated CD and gastrointestinal disease controls were tested and receiver operator characteristics were used to calculate cutoffs., Results: MALDI-TOF revealed a number of fragments matching known HMW-GS-1Dy10 sequences within both the deamidated and non-deamidated material. Evidence of deamidation of glutamine residues was found only within the human transglutaminase-treated material. Patients with untreated CD had significantly increased levels of serum antibodies to HMW-GS-1Dy10 compared to controls. Undeamidated HMW-GS-1Dy10 IgA antibodies had sensitivities and specificities of 72.5 and 78.26%, respectively. Deamidated HMW-GS-1Dy10 IgA antibodies had sensitivities and specificities of 76.8 and 65.2%. Undeamidated HMW-GS-1Dy10 IgG antibodies had sensitivities and specificities of 75.3 and 68.1%. Deamidated HMW-GS-1Dy10 IgG antibodies had sensitivities and specificities of 36.2 and 92.8%., Conclusion: Patients with untreated CD have raised antibody levels to HMW-GS-1Dy10, indicating the participation of these proteins in the adaptive immune response to gluten. Discrimination between CD patients and controls is not enhanced by deamidation of HMW-GS-1Dy10. Thus antibodies to these proteins are not useful markers for CD detection., (Copyright © 2012 S. Karger AG, Basel.)
- Published
- 2012
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24. Gluten sensitivity and the CNS: diagnosis and treatment.
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Versino M, Biagi F, Bianchi PI, Zardini E, Colnaghi S, Moglia A, Corazza GR, and Franciotta D
- Subjects
- Adult, Female, Humans, Brain Diseases diagnosis, Brain Diseases therapy, Celiac Disease diagnosis, Celiac Disease therapy, Glutens
- Published
- 2010
- Full Text
- View/download PDF
25. Anti-goblet cell antibodies for the diagnosis of autoimmune enteropathy?
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Biagi F, Bianchi PI, Trotta L, and Corazza GR
- Subjects
- Autoimmune Diseases blood, Biomarkers blood, Female, Humans, Malabsorption Syndromes blood, Male, Middle Aged, Prospective Studies, Autoantibodies immunology, Autoimmune Diseases diagnosis, Autoimmune Diseases immunology, Goblet Cells immunology, Malabsorption Syndromes diagnosis, Malabsorption Syndromes immunology
- Published
- 2009
- Full Text
- View/download PDF
26. The impact of misdiagnosing celiac disease at a referral centre.
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Biagi F, Bianchi PI, Campanella J, Zanellati G, and Corazza GR
- Subjects
- Adult, Antibodies immunology, Biopsy methods, Celiac Disease immunology, Celiac Disease pathology, Duodenum pathology, Female, Humans, Male, Middle Aged, Referral and Consultation, Retrospective Studies, Young Adult, Antibodies analysis, Celiac Disease diagnosis, Diagnostic Errors
- Abstract
In the past few years, the number of celiac disease diagnoses not confirmed at the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, a tertiary referral centre, was particularly high. Therefore, a decision was made to investigate the reasons why these diagnoses were wrong and by whom they had been made. The clinical histories of all celiac patients referred to the centre were re-evaluated. Between December 1998 and January 2007, 614 patients who were diagnosed at other institutions and presumed to be affected by celiac disease attended the tertiary referral outpatient clinic. The histological and serological results allowed for confirmation the diagnosis in 434 patients. In the remaining 180 patients, the initial diagnosis of celiac disease could not be confirmed; therefore, the patients were re-investigated. After re-evaluation, the diagnosis of celiac disease was confirmed in only 61 of these 180 cases. The reasons for incorrect initial diagnosis were analyzed. A mere 80% correct diagnosis rate is a very disappointing result. Although it should be obvious that celiac disease must be investigated with duodenal biopsies and celiac antibody testing, this well-known strategy is not always followed, probably resulting in an incorrect diagnosis.
- Published
- 2009
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27. Cerebellar signs in celiac disease.
- Author
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Versino M, Franciotta D, Colnaghi S, Biagi F, Zardini E, Bianchi PI, Corazza GR, and Cosi V
- Subjects
- Adolescent, Adult, Aged, Autoantibodies analysis, Autoantibodies blood, Celiac Disease physiopathology, Cerebellar Diseases diagnosis, Cerebellar Diseases physiopathology, Cerebellar Nuclei physiopathology, Cerebellum immunology, Cerebellum physiopathology, Demyelinating Autoimmune Diseases, CNS physiopathology, Female, Glutens immunology, Humans, Male, Middle Aged, Neurologic Examination, Ocular Motility Disorders diagnosis, Ocular Motility Disorders immunology, Ocular Motility Disorders physiopathology, Reflex, Vestibulo-Ocular immunology, Saccades immunology, Young Adult, Celiac Disease complications, Celiac Disease immunology, Cerebellar Diseases immunology, Demyelinating Autoimmune Diseases, CNS immunology
- Published
- 2009
- Full Text
- View/download PDF
28. The prevalence and the causes of minimal intestinal lesions in patients complaining of symptoms suggestive of enteropathy: a follow-up study.
- Author
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Biagi F, Bianchi PI, Campanella J, Badulli C, Martinetti M, Klersy C, Alvisi C, Luinetti O, and Corazza GR
- Subjects
- Adult, Autoantibodies immunology, Biopsy, Celiac Disease immunology, Celiac Disease pathology, Diagnosis, Differential, Disease Progression, Duodenal Diseases pathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Risk, Duodenum, Intestinal Diseases pathology, Intestinal Mucosa pathology
- Abstract
Aims: Although they are non-specific, minimal intestinal lesions are at the end of the coeliac histological damage spectrum. To investigate whether minimal intestinal lesions in patients without endomysial antibodies are due to coeliac disease, their prevalence, causes and risk of evolving into frank coeliac disease were studied., Methods: From January 2000 to December 2005, 645 duodenal biopsies were performed. In 209 patients, duodenal biopsies were performed independently of endomysial antibody results. Clinical data and HLA-typing of all the patients negative to endomysial antibodies but with minimal mucosal lesions were re-evaluated. Three years later, they were offered to be seen again, and further investigations were proposed., Results: 14 out of 209 patients had minimal mucosal lesions and negative endomysial antibodies. Two patients were lost to follow-up; in 7/12 patients, symptoms and histological lesions were due to a different condition, not related to coeliac disease. In 11/12 patients, HLA-typing made diagnosis of coeliac disease very unlikely. Only one patient was on a gluten-free diet because of gluten-sensitive symptoms and was DQ2(+)/DQ8(+)., Conclusions: Minimal duodenal lesions in patients negative to endomysial antibodies are rare and are likely to be due to conditions unrelated to coeliac disease.
- Published
- 2008
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29. The incidence of coeliac disease in adult first degree relatives.
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Biagi F, Campanella J, Bianchi PI, Zanellati G, Capriglione I, Klersy C, and Corazza GR
- Subjects
- Adult, Celiac Disease diagnosis, Family, Female, Fluorescent Antibody Technique, Indirect, Follow-Up Studies, Humans, Immunoglobulin A blood, Incidence, Male, Middle Aged, Celiac Disease epidemiology, Celiac Disease genetics, Genetic Predisposition to Disease
- Abstract
Background and Aims: Although prevalence of coeliac disease among first degree relatives of coeliac patients is well-known, only four studies are available about its incidence. We investigated whether first degree relatives found to be negative at a first serological screening can subsequently develop coeliac disease., Patients and Methods: In the last 6 years, endomysial antibodies were tested in 158 adult first degree relatives referred to our coeliac out-patient clinic. After at least a year, negative subjects were offered a second testing. Sixty-three accepted., Results: 130/158 first degree relatives tested negative initially. Although one of them had developed coeliac disease after the first testing, at the second testing none of the 63 endomysial antibody negative first degree relatives proved positive. Incidence of coeliac disease among first degree relatives was 1/64 in 51 months, 0.437% year (95%CI 0.05-2.62). An analysis of the sample size showed that 10,000 first degree relatives must be followed up to significantly reduce the CI., Conclusions: Although we confirmed the high prevalence of coeliac disease among first degree relatives (28/158, 17.7%), we found that the low incidence suggests that further studies are required to understand whether endomysial antibody negative first degree relatives need to be followed up.
- Published
- 2008
- Full Text
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30. Clinical response to gluten withdrawal is not an indicator of coeliac disease.
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Campanella J, Biagi F, Bianchi PI, Zanellati G, Marchese A, and Corazza GR
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Biopsy, Needle, Celiac Disease etiology, Celiac Disease pathology, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Severity of Illness Index, Celiac Disease diagnosis, Celiac Disease diet therapy, Diet, Gluten-Free, Duodenum pathology, Glutens adverse effects
- Abstract
Objective: Although the diagnosis of coeliac disease requires specific histological and serological findings, patients considered to be affected by coeliac disease only on the basis of clinical improvement after gluten withdrawal are commonly referred to our outpatient clinic. The objective of this study was to investigate whether the clinical response of gastrointestinal symptoms to gluten withdrawal and subsequent dietary re-introduction could be an indicator of the presence of coeliac disease., Material and Methods: From December 1998 to January 2007, 180 patients on a gluten-free diet because of a diagnosis of coeliac disease not based on proper diagnostic criteria came to our out-patient clinic. In 112 of these patients, gluten was re-introduced into their diet. Subsequent duodenal biopsies and endomysial antibodies confirmed the diagnosis of coeliac disease in 51 of them. The relationship between improvement/worsening of symptoms and withdrawal/re-introduction of dietary gluten was analysed., Results: Gastrointestinal symptoms improved in 64.7% of coeliac patients and 75.0% of non-coeliac patients after gluten withdrawal (chi(2) test, p=NS). Gluten re-introduction was followed by clinical exacerbation in 71.4% of coeliac patients and 54.2% of non-coeliac patients (chi(2) test, p=NS). The positive predictive value for clinical improvement after gluten withdrawal was 36%; the positive predictive value for clinical exacerbation after gluten re-introduction was 28%., Conclusions: Clinical response to either withdrawal or re-introduction of dietary gluten has no role in the diagnosis of coeliac disease.
- Published
- 2008
- Full Text
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31. Is a gluten-free diet necessary in patients with potential celiac disease?
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Biagi F, Campanella J, Bianchi PI, and Corazza GR
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Time Factors, Celiac Disease diagnosis, Celiac Disease diet therapy, Glutens administration & dosage
- Abstract
Potential celiac disease is characterized by a normal duodenal mucosa despite high intraepithelial lymphocytes count and/or positive endomysial antibodies while on a gluten-containing diet. An agreement about the management of this condition is still lacking. A 68-year-old lady complaining of weight loss and epigastric pain was found to be affected by potential celiac disease. Although she maintained a gluten-containing diet, epigastric pain and weight loss disappeared. If she had started a gluten-free diet, the improvement would have been considered a demonstration of the beneficial effect of the diet. Potential celiac patients can be maintained on a gluten-containing diet providing they are closely followed up.
- Published
- 2007
32. Video capsule endoscopy and histology for small-bowel mucosa evaluation: a comparison performed by blinded observers.
- Author
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Biagi F, Rondonotti E, Campanella J, Villa F, Bianchi PI, Klersy C, De Franchis R, and Corazza GR
- Subjects
- Adolescent, Adult, Aged, Atrophy pathology, Biopsy, Duodenum pathology, Female, Gastroscopy, Humans, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Sensitivity and Specificity, Endoscopy, Gastrointestinal methods, Intestinal Mucosa pathology, Intestine, Small pathology, Video Recording
- Abstract
Background & Aims: In view of the excellent quality of the images obtained and its magnification capability, videocapsule endoscopy was proposed as a promising tool to evaluate the degree of duodenal villous atrophy. We studied whether the capsule can discriminate different degrees of mucosal damage caused by different conditions; we also evaluated interobserver and intraobserver variability in the assessment of villous atrophy with the capsule., Methods: Thirty-two patients underwent both gastroscopy with multiple duodenal biopsies and videocapsule endoscopy. Twenty-six had different forms of celiac disease with different stages of villous atrophy; 5 patients had irritable bowel syndrome and 1 had Crohn's disease. Videocapsule findings were evaluated blindly by 3 observers. Histologic Marsh criteria and a specifically developed classification of videocapsule mucosal patterns were used to compare videocapsule findings and histology., Results: The study of the correlation between videocapsule and histologic findings showed a Kappa statistic of .45, .49, and .51 for observers 1, 2, and 3, respectively. The sensitivity was 90.5% for observer 1 and 95.2% for observers 2 and 3; the specificity was 63.6% for all observers., Conclusions: Videocapsule findings regarding the degree of intestinal mucosal atrophy show only moderate agreement with the histologic pattern; they have a very high sensitivity but a disappointing specificity. This method therefore cannot be proposed as an alternative to traditional biopsy examinations, but it suggests that a duodenal biopsy examination should be performed when an atrophic mucosal pattern is observed in patients undergoing videocapsule examination for other reasons.
- Published
- 2006
- Full Text
- View/download PDF
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