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Background Therapeutic armamentarium of inflammatory bowel disease (IBD) has expanded, including several intravenous (IV) and subcutaneously administered biological agents and orally administered small molecules (SMs). Additionally, some biologics initially available only for IV administration also have subcutaneous (SC) formulations. However, transitioning from in-hospital IV treatment to SC or oral home therapy can lead to some patient concerns, mainly linked to the need for self-administration and managing side effects. This study aimed to evaluate the opinion of IBD patients on the transition to oral or SC treatment, considering multiple socio-demographic factors, the frequency of biologic agent infusion, and the commitments (personal, family, work) associated with the in-hospital administration of therapy. In addition, patients were asked about their knowledge of new therapeutic options and their expectations about this management modality. Methods We conducted a survey using a questionnaire prepared by a team of gastroenterologists and nurses working at the IBD Unit of the CEMAD-Policlinico Gemelli of Rome. The survey was administered to consecutive IBD patients in stable IV biological treatment from January to October 2022. It consists of 31 items and has been divided into four sections: descriptive, commitment, knowledge and passage mode opinion. Results 311 patients responded to the survey from 400 questionnaires (77.7%). 49.8% favored switching from IV to oral or SC therapy, and only 25.1% disagreed. In univariate and multivariate analysis, the home therapy approval rate was significantly associated with the distance from the IBD center (Fig. 1) and work/family/personal commitments. Surprisingly, only about a quarter of the IBD patients knew that almost all the following available therapeutic agents will have an SC administration route or will be SMs (Fig. 2). Regarding patients' opinion on the efficacy of SMs or SC administration of biological agents compared to IV drugs: 63% had no definite idea, while 14% believed that the effectiveness could be reduced. 23.8% of patients would like to be reassured by their gastroenterologist or nurse on the efficacy and safety of these new therapeutic options, and 7.7% would like to know the scientific data from studies on this issue. Conclusion The transition from in-hospital to the home therapeutic management of biological therapy with SC or oral agents was generally viewed favorably by patients, especially if they have commitments or are residents far from the IBD center. However, to reduce patient concerns and encourage this change, it is necessary to implement a patient training and information program involving all the IBD unit care figures, including IBD nurses.

Background Nephrolithiasis (NL) is a common extra-intestinal complication of inflammatory bowel disease (IBD) with recognizable morbidity and mortality. However, its pathogenesis and risk factors are not completely elucidated yet. Because of intestinal malabsorption, enteric hyperoxaluria is a crucial pathogenic mechanism responsible for developing urinary stones in IBD patients. In recent decades, growing evidence has highlighted the association between gut microbiota and NL, with a particular emphasis on the role of some oxalate-degrading bacteria, such as Oxalobacter formigenes, representing the mainstay of the so-called “gut-kidney axis.” More recent studies also hypothesize the involvement of urinary microbiota, but no data on IBD patients are available. Thus, we conducted a pilot study to analyse the urinary lithogenic profile in IBD patients and its relationship with gut and urinary microbiota. Methods Consecutive patients with IBD were prospectively enrolled. The presence of ileoanal pouch, ileostomy, colostomy, or short-bowel syndrome were exclusion criteria. Demographic and clinical data, including previous episodes of NL, were collected. Disease activity was evaluated using Harvey-Bradshaw and Mayo scores for Crohn’s disease (CD) and ulcerative colitis (UC). All patients underwent abdominal ultrasound for NL detection, and blood tests of kidney function (creatinine, blood urea nitrogen, creatinine clearance, electrolytes) were also measured, together with 24h-urine collection for lithogenic profile analysis, including calcium oxalate relative saturation ratio (RSRCaOx). In a subgroup of patients, urinary and faecal microbiota were also analysed through 16S rRNA sequencing. Results 36 patients (20 CD and 16 UC) were enrolled. NL was more frequent in CD than in UC (25% vs. 6.25%). 24-h oxaluria was significantly increased in patients with previous or present NL (p=0.02), and RSRCaOx was significantly higher in CD than in UC (p=0.02) (Figure 1). Gut microbiota analysis revealed a higher relative abundance of Bacteroidetes and a lower abundance of Firmicutes in patients with an elevated RSRCaOx, defined for values more than the median (Figure 2). No statistically significant differences were observed in urinary microbiota composition in relation to high or low levels of RSRCaOx. Conclusion NL is more common in IBD patients with higher oxaluria levels, confirming oxalate excretion's crucial role in NL pathogenesis. Furthermore, our study reports an association between urinary stone development and Firmicutes/Bacteroidetes imbalance in the gut microbiota, suggesting possible further studies to identify patients at higher risk of NL.

For survivors of severe COVID-19 disease, having defeated the virus is just the beginning of an uncharted recovery path. What follows after the acute phase of SARS-CoV-2 infection depends on the extension and severity of viral attacks in different cell types and organs. Despite the ridiculously large number of papers that have flooded scientific journals and preprint-hosting websites, a clear clinical picture of COVID-19 aftermath is vague at best. Without larger prospective observational studies that are only now being started, clinicians can retrieve information just from case reports and or small studies. This is the time to understand how COVID-19 goes forward and what consequences survivors may expect to experience. To this aim, a multidisciplinary post-acute care service involving several specialists has been established at the Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). Although COVID-19 is an infectious disease primarily affecting the lung, its multi-organ involvement requires an interdisciplinary approach encompassing virtually all branches of internal medicine and geriatrics. In particular, during the post-acute phase, the geriatrician may serve as the case manager of a multidisciplinary team. The aim of this article is to describe the importance of the interdisciplinary approach––coordinated by geriatrician––to cope the potential post-acute care needs of recovered COVID-19 patients.

Background Ulcerative colitis is a chronic invalidating disease, whose therapeutic strategies include amino-salicylates, steroids, probiotics, immune-modulators, biologics, fecal microbiota transplantation and surgery. In clinical practice, there is little evidence available about elements that could predict response to each of the above-mentioned therapies. Our study suggests that OCTN1, an organic cation transporter directly involved in innate immunity, with its variants (C503L homozygous, heterozygous or T503F), could have a role in predicting individual response to biologic therapies (antiTNFa and vedolizumab). Methods In this prospective study, we enrolled a cohort of, 80 patients with active ulcerative colitis (51 in treatment with anti-TNF alpha agents and, 29 with vedolizumab), determining their OCTN1 genotype and evaluating their clinical response to therapy, calculated with clinical Mayo score, after six weeks (T1), six months (T2) and after three years (T3). Results Left colitis at diagnosis was more frequent in C503L patients (60% left colitis vs, 40% pancolitis) than patients with T503F (42.8% left colitis vs, 57.2 pancolitis). In the same way, the average age at diagnosis was sensibly lower in patients with T503F genotype (34.7 years C503L vs, 25 years T503F). We used clinical response at T2 (6 months) as a primary outcome of our study. Among patients under anti-TNF alpha therapies, patients with C503L genotype were divided into, 8 no responders and, 6 responders (43% responders vs, 57% no responders); patients with T503F genotype were divided into, 10 responders and, 2 no responder (80% responders vs, 20% no responders). On the contrary, patients under vedolizumab therapy showed different trends: patients with C503L genotype were divided into, 12 responders and, 3 no responders (83% responders vs, 17% no responders); patients with T503F genotype were, 1 responder and, 1 no responder (50% responders vs, 50% no responders). After, 3 years, patients responders to anti-TNF alpha therapies at T2, with T503F genotype, still maintain the response to the same drug. Conclusion Patients with the T503F genotype present an overall worse course of the disease, with a higher rate of pancolitis and younger age at diagnosis. Patients with the C503L genotype showed a better response to vedolizumab, whilst patients with the T503F genotype showed a better response to anti-TNF alpha. We can therefore conclude that the presence of the mutation (allele T) increases the response rate to anti-TNF alpha, especially for the homozygous mutated genotype (OR=371.82, p=0.009), but for the heterozygous genotype as well (OR=10.95, p=0.088).