Dario Conte

Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Lombardy, Italy

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Publications (339)1972.69 Total impact

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    ABSTRACT: Gastric carcinoids (GCs) are classified as: type I, related to hypergastrinemia due to chronic atrophic gastritis (CAG), type II, associated with Zollinger-Ellison syndrome in multiple endocrine neoplasia type 1, and type III, which is normogastrinemic. The management of type-I gastric carcinoids (GC1s) is still debated, because of their relatively benign course. According to the European Neuroendocrine Tumor Society guidelines endoscopic resection is indicated whenever possible; however, it is not often feasible because of the presence of a multifocal disease, large lesions, submucosal invasion or, rarely, lymph node involvement. Therefore, somatostatin analogs (SSAs) have been proposed as treatment for GC1s in view of their antisecretive, antiproliferative and antiangiogenic effects. However, in view of the high cost of this therapy, its possible side effects and the relatively benign course of the disease, SSAs should be reserved to specific subsets of "high risk patients", i.e., those patients with multifocal or recurrent GCs. Indeed, it is reasonable that, after the development of a gastric neuroendocrine neoplasm in patients with a chronic predisposing condition (such as CAG), other enterochromaffin-like cells can undergo neoplastic proliferation, being chronically stimulated by hypergastrinemia. Therefore, definite indications to SSAs treatment should be established in order to avoid the undertreatment or overtreatment of GCs.
    World Journal of Gastroenterology 06/2015; 21(22). DOI:10.3748/wjg.v21.i22.6785 · 2.43 Impact Factor
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    ABSTRACT: Reporting on three cases of gastric neuroendocrine tumors (g-NETs) in patients taking long-term proton pump inhibitors (PPIs). These tumors are not classifiable considering current criteria. g-NETs are currently grouped as: types 1 and 2, related to hypergastrinemia due to chronic atrophic gastritis and Zollinger-Ellison syndrome respectively, and type 3, normogastrinemic and more aggressive. Although the g-NETs onset in patients taking PPIs is biologically plausible, only a few cases have been reported so far. From January 2005 to July 2014, 31 g-NETs were referred to our Unit: 24 (77%), one (3%) and three (10%) resulted types 1, 2 and 3, respectively. Three cases (10%) did not meet the current classification criteria. The three patients were administered long-term PPIs for gastro-esophageal reflux disease. Patient 1: a 78-year-old man, with a 4-mm well-differentiated g-NET (Ki-67<1%) and marked hypergastrinemia. Patient 2: a 58-year-old man affected by a 6-mm well-differentiated (Ki-67 = 4%) g-NET, with normal gastrin levels. Patients 3: a 67-year-old woman with an 18-mm well-differentiated g-NET (Ki-67 <2%), with mild hypergastrinemia. In the three patients, histology and pertinent blood tests excluded chronic atrophic gastritis, Helicobacter pylori infection or Zollinger-Ellison syndrome. The first two patients underwent endoscopic polypectomy; in the third case total gastrectomy was performed. Further clinical, endoscopic and imaging follow-up did not show any g-NET recurrence. The present data point to the existence and epidemiological relevance of g-NETs associated with PPIs intake. These neoplasms are not included in the current classification, thus their treatment and follow-up have not been established.
    Scandinavian Journal of Gastroenterology 06/2015; DOI:10.3109/00365521.2015.1054426 · 2.33 Impact Factor
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    ABSTRACT: Malnutrition is common in alcoholic liver disease and is associated with high rates of complications and mortality. In this article, the current literature was reviewed to highlight the relevance of proper nutritional management providing levels of evidence, when available. A PubMed search was performed for English-language publications from 1980 through 2014 with the keywords: alcoholic liver disease, nutritional deficiencies, nutritional support, enteral nutrition, parenteral nutrition, and protein-energy malnutrition. Manuscripts focused on nutritional approach in patients with alcoholic liver disease were selected.
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    ABSTRACT: The addition of impedance to 24-h pH monitoring has allowed detection of weakly acidic reflux, but the extent to which pH-impedance (pH-MII) monitoring improves outcomes is unknown. This was a prospective observational study. Patients referred for pH or pH-MII monitoring completed a standardized questionnaire on improvement in the dominant symptom, their satisfaction, and treatment at 3 and 12 months after the test during a telephone interview. A total of 184 patients (mean age, 52 years, range, 19-82 years; 35 % with typical symptoms; and 89 % tested off therapy) completed pH (n = 92) or pH-MII monitoring (n = 92) over a period of 15 months. The two arms were similar in terms of demographic, clinical, and endoscopic variables. Ten patients in the pH-MII arm showed evidence of weakly acidic reflux disease. There was no difference in the percentage of patients in the pH and pH-MII monitoring arms who experienced improvement in their dominant symptom after 3 (58 vs. 63 %; p = 0.621) or 12 months (66 vs. 70 %; p = 0.234), and the same was true for patient satisfaction. There were also no between-group difference in the use of proton pump inhibitors (PPIs) after 3 (63 vs. 68.5 %; p = 0.437) or 12 months (47 vs. 60.5 %; p = 0.051). PPIs were prescribed more frequently after a positive test (p < 0.001) although they were used by 45.6 % of the negative patients. Only one patient underwent fundoplication. Two-thirds of patients undergoing pH-MII monitoring experience a positive outcome, similarly to what occurs after traditional pH monitoring. Physicians often pay little attention to the test results, especially if they are negative.
    Journal of Gastroenterology 06/2015; DOI:10.1007/s00535-015-1090-z · 4.02 Impact Factor
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    ABSTRACT: In 2013, four Italian Gastroenterological Societies (the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition, the Italian Society of Hospital Gastroenterologists and Endoscopists, the Italian Society of Endoscopy, and the Italian Society of Gastroenterology) formed a joint panel of experts with the aim of preparing an official statement on transition medicine in Gastroenterology. The transition of adolescents from paediatric to adult care is a crucial moment in managing chronic diseases such as celiac disease, inflammatory bowel disease, liver disease and liver transplantation. Improved medical treatment and availability of new drugs and surgical techniques have improved the prognosis of many paediatric disorders, prolonging survival, thus making the transition to adulthood possible and necessary. An inappropriate transition or the incomplete transmission of data from the paediatrician to the adult Gastroenterologist can dramatically decrease compliance to treatment and prognosis of a young patient, particularly in the case of severe disorders. For these reasons, the Italian gastroenterological societies decided to develop an official shared transition protocol. The resulting document discusses the factors influencing the transition process and highlights the main points to accomplish to optimize compliance and prognosis of gastroenterological patients during the difficult transition from childhood to adolescence and adulthood. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
    Digestive and Liver Disease 04/2015; DOI:10.1016/j.dld.2015.04.002 · 2.89 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-825. DOI:10.1016/S0016-5085(15)32805-5 · 13.93 Impact Factor
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    ABSTRACT: Epithelial-to-Mesenchymal Transition (EMT) is relevant in malignant growth and frequently correlates with worsening disease progression due to its implications in metastases and resistance to therapeutic interventions. Although EMT is known to occur in several types of solid tumors, the information concerning tumors arising from the epithelia of the bile tract is still limited. In order to approach the problem of EMT in cholangiocarcinoma, we decided to investigate the changes in protein expression occurring in two cell lines under conditions leading to growth as adherent monolayers or to formation of multicellular tumor spheroids (MCTS), which are considered culture models that better mimic the growth characteristics of in-vivo solid tumors. In our system, changes in phenotypes occur with only a decrease in transmembrane E-cadherin and vimentin expression, minor changes in the transglutaminase protein/activity but with significant differences in the proteome profiles, with declining and increasing expression in 6 and in 16 proteins identified by mass spectrometry. The arising protein patterns were analyzed based on canonical pathways and network analysis. These results suggest that significant metabolic rearrangements occur during the conversion of cholangiocarcinomas cells to the MCTS phenotype, which most likely affect the carbohydrate metabolism, protein folding, cytoskeletal activity, and tissue sensitivity to oxygen.
    PLoS ONE 03/2015; 10(3):e0118906. DOI:10.1371/journal.pone.0118906 · 3.53 Impact Factor
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    Digestive and Liver Disease 03/2015; Vol 47(Supplement 2):e199. · 2.89 Impact Factor
  • Digestive and Liver Disease 03/2015; Vol 47(Supplement 2):e147. · 2.89 Impact Factor
  • Digestive and Liver Disease 03/2015; Vol 47(Supplement 2):e87. DOI:10.1016/S0016-5085(15)30096-2 · 2.89 Impact Factor
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    ABSTRACT: The performance of pocket mobile ultrasound devices (PUDs) is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit. We assessed whether the use of PUD in the context of physical examination can reduce the prescription of additional tests when used by physicians in different clinical settings. We conducted a cohort impact study in four hospital medical wards, one gastroenterological outpatient clinic, and 90 general practices in the same geographical area. The study involved 135 physicians who used PUD, after a short predefined training course, to examine 1962 consecutive patients with one of 10 diagnostic hypotheses: ascites, pleural effusion, pericardial effusion, urinary retention, urinary stones, gallstones, biliary-duct dilation, splenomegaly, abdominal mass, abdominal aortic aneurysm. According to the physicians' judgment, PUD examination could rule out or in the diagnostic hypothesis or require further testing; the concordance with the final diagnosis was assessed. The main outcome was the proportion of cases in which additional tests were required after PUD. The PUD diagnostic accuracy was assessed in patients submitted to further testing. The 1962 patients included 37% in-patients, 26% gastroenterology outpatients, 37% from general practices. Further testing after PUD examination was deemed unnecessary in 63%. Only 5% of patients with negative PUD not referred for further testing were classified false negatives with respect to the final diagnosis. In patients undergoing further tests, the sensitivity was 91%, and the specificity 83%. After a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing.
    Digestive and Liver Disease 02/2015; 47(3):e35-e36. DOI:10.1016/j.dld.2015.01.079 · 2.89 Impact Factor
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    Digestive and Liver Disease 02/2015; 47:e50-e51. DOI:10.1016/j.dld.2015.01.110 · 2.89 Impact Factor
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    ABSTRACT: Appendiceal Goblet cell tumors (GCTs) are clinically more aggressive, and have a worse outcome than midgut neuroendocrine tumors (mNETs). Guidelines for management of GCTs are limited. A retrospective case-study analysis was performed in patients with a diagnosis of GCT, confirmed on histological review. Patients were evaluated clinically, biochemically, and radiologically. 48 patients were identified (TNM stage I-II: 27, stage III: 15, stage IV: 6). Median follow-up was 44 months and was complete in all patients. 68.8% presented with acute appendicitis. 44/48 patients had initial appendectomy, followed by prophylactic right hemicolectomy in 41. 10/48 patients had recurrent disease [median time to recurrence 28 months (range 4-159)]. Of those, 9 received systemic chemotherapy (FOLFOX/FOLFIRI), which was also given in 5/48 patients with disseminated disease at diagnosis. Partial response, stable disease and disease progression was noted in 22%, 22% and 56%, respectively. Adjuvant chemotherapy was also administered in 9/48 patients with stage III disease after right hemicolectomy, however in 3/9 the disease recurred. Median progression/disease-free-survival was 44 months (range 3-159) and overall 5-year survival rate was 41.6%. The clinical behaviour of GCTs is more similar to colorectal adenocarcinomas than to NETs. A prophylactic right hemicolectomy is recommended to reduce the risk of recurrence. Systemic chemotherapy, using colorectal adenocarcinoma regimens, is indicated for advanced or recurrent disease and has encouraging results. Prospective studies are needed to define the role of adjuvant chemotherapy and the optimal chemotherapy regimen. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Surgical Oncology 01/2015; 24(1). DOI:10.1016/j.suronc.2015.01.001 · 2.37 Impact Factor
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    ABSTRACT: Background and Aims. Hepatic hemangioma (HH) has a widely ranging prevalence. The etiology is unclear; however, associations with autoimmune disorders have been described. We aimed at evaluating the prevalence of HH in celiac disease. Methods. Ninety-seven consecutive patients with celiac disease (18 M, 79 F, median age 41, and range 17-84 years) underwent liver ultrasound between January 2011 and 2012. The findings were compared with those of 1352 nonceliac patients (581 M, 771 F, median age 50, and range 16-94 years), without liver disease or previously detected HH, who underwent US in the same period. Results. Ultrasonographic findings consistent with HH were observed in 14 celiac patients (14.4%), a prevalence significantly higher than in controls (69 cases, 5.1%) (P = 0.0006). Subgroup analysis showed that, among women, the prevalence of HH was 16.4% in the celiac disease group (13/79) compared with 5.9% in controls (46/771) (P = 0.002). In celiac setting, HH had a median diameter of 1.3 cm and presented as a single lesion in 12 cases (86%). Conclusions. Our findings are consistent with a significantly higher prevalence of HH in celiac patients. Although mechanisms underlying this association remain unclear, autoimmune and metabolic processes, as well as alterations of gut-liver axis equilibrium, could play a role.
    Gastroenterology Research and Practice 01/2015; 2015:1-6. DOI:10.1155/2015/749235 · 1.50 Impact Factor
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    The American Journal of Gastroenterology 01/2015; 110(1):200-2. DOI:10.1038/ajg.2014.354 · 9.21 Impact Factor
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    ABSTRACT: Background and Aim. Although mercury is involved in several immunological diseases, nothing is known about its implication in celiac disease. Our aim was to evaluate blood and urinary levels of mercury in celiac patients. Methods. We prospectively enrolled 30 celiac patients (20 treated with normal duodenal mucosa and 10 untreated with duodenal atrophy) and 20 healthy controls from the same geographic area. Blood and urinary mercury concentrations were measured by means of flow injection inductively coupled plasma mass spectrometry. Enrolled patients underwent dental chart for amalgam fillings and completed a food-frequency questionnaire to evaluate diet and fish intake. Results. Mercury blood/urinary levels were 2.4 ± 2.3/1.0 ± 1.4, 10.2 ± 6.7/2.2 ± 3.0 and 3.7 ± 2.7/1.3 ± 1.2 in untreated CD, treated CD, and healthy controls, respectively. Resulting mercury levels were significantly higher in celiac patients following a gluten-free diet. No differences were found regarding fish intake and number of amalgam fillings. No demographic or clinical data were significantly associated with mercury levels in biologic samples. Conclusion. Data demonstrate a fourfold increase of mercury blood levels in celiac patients following a gluten-free diet. Further studies are needed to clarify its role in celiac mechanism.
    Gastroenterology Research and Practice 01/2015; 2015:953042. DOI:10.1155/2015/953042 · 1.50 Impact Factor
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    ABSTRACT: Abnormalities in liver function tests, including transient and self-limiting hypertransaminasemia, cholestatic disease and hepatitis, can develop during treatment with anti-tumour-necrosis-factor (TNF) therapy. The optimal management of liver injury related to anti-TNF therapy is still a matter of debate. Although some authors recommend discontinuing treatment in case of both a rise of alanine aminotransferase more than 5 times the upper limit of normal, or the occurrence of jaundice, there are no standard guidelines for the management of anti-TNF-related liver injury. Bibliographical searches were performed in PubMed, using the following key words: inflammatory bowel disease (IBD); TNF inhibitors; hypertransaminasemia; drug-related liver injury; infliximab. According to published data, elevation of transaminases in patients with IBD treated with anti-TNF is a common finding, but resolution appears to be the usual outcome. Anti-TNF agents seem to be safe with a low risk of causing severe drug-related liver injury. According to our centre experience, we found that hypertransaminasemia was a common, mainly self-limiting finding in our IBD cohort and was not correlated to infliximab treatment on both univariate and multivariate analyses. An algorithm for the management of liver impairment occurring during anti-TNF treatment is also proposed and this highlights the need of a multidisciplinary approach and suggests liver biopsy as a key-point in the management decision in case of severe rise of transaminases. However, hepatic injury is generally self-limiting and drug withdrawal seems to be an exception.
    World Journal of Gastroenterology 12/2014; 20(46):17352-17359. DOI:10.3748/wjg.v20.i46.17352 · 2.43 Impact Factor
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    ABSTRACT: Background/Aims: Plasma chromogranin A (CgA) is the most widely used biochemical biomarker in the diagnostic work-up and follow-up of gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs). Herein, we assessed the clinical utility of CgA in diagnosing and monitoring a large series of GEP-NENs. Patients and Methods: 181 GEP-NEN patients (87 males, 94 females), with pancreatic (81) and gastrointestinal (100) neoplasm, were included. 99 patients were G1 (Ki-67 ≤2%) NENs, 57 G2 (Ki-67 3-20%), 25 G3 (Ki-67 >20%). 81 patients were at TNM stage I, 14 at II, 17 at III, 69 at IV. For every patient, CgA values were assessed at diagnosis and during follow-up. Results: At diagnosis the CgA values were above the upper reference limit in 148 patients (82%): the median CgA levels were significantly higher in functioning than non-functioning tumors (295 vs. 43 U/l, p = 0.0001) and in patients with metastases than without (324.5 vs. 42 U/l, p = 0.0001). At logistic regression analysis the baseline CgA levels were significantly associated with the Ki-67 index (p < 0.0001) and the TNM stage (p < 0.0001), independently of the age and sex of the patient and the primary site of the tumor. The overall 5 and 10-year survival was 74% and 64.5%, respectively. The low Ki-67 index, the type of treatment and the early CgA decrease after treatment were positively correlated with the survival rate. After radical surgery, 15/95 patients relapsed and an increase in CgA values anticipated the clinical and objective disease recurrence after a period of 9-12 months. Conclusions: In GEP-NENs plasma CgA carries a significant prognostic meaning. © 2015 S. Karger AG, Basel.
    Neuroendocrinology 11/2014; 100(2-3). DOI:10.1159/000369818 · 4.93 Impact Factor
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    ABSTRACT: It has been suggested that multiple rapid swallowing should be added to oesophageal manometry. To prospectively evaluate whether 10 and 200mL multiple rapid swallowing provide different information concerning motor function. 30 consecutive patients with oesophageal symptoms, 13 achalasia patients after successful pneumatic dilation and 19 healthy subjects performed eight 5mL single swallows, two 10mL and one 200mL multiple rapid swallowing. Almost all of the healthy subjects and two-thirds of the patients with oesophageal symptoms showed motor inhibition during both 10 and 200mL multiple rapid swallowing. The oesophago-gastric pressure gradient was significantly higher during 200mL multiple rapid swallowing within each group (p<0.01), and significantly higher in the achalasia patients than in the other two groups (p<0.0001). Presence of a contraction and increased contraction strength in comparison with single swallows were both more frequent after 10mL than after 200mL multiple rapid swallowing in the healthy subjects and the patients (p<0.05). Motor inhibition could be similarly evaluated by means of 10 and 200mL multiple rapid swallowing; 10mL evaluated the after-contraction, whereas 200mL multiple rapid swallowing was more valuable in identifying increased resistance to outflow. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. All rights reserved.
    Digestive and Liver Disease 11/2014; 47(2). DOI:10.1016/j.dld.2014.10.007 · 2.89 Impact Factor

Publication Stats

5k Citations
1,972.69 Total Impact Points

Institutions

  • 2006–2015
    • Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
      • • Endocrinology and Diabetology
      • • Gastroenterology 3
      Milano, Lombardy, Italy
    • Azienda Ospedaliera Treviglio
      Treviglio, Lombardy, Italy
  • 1986–2015
    • University of Milan
      • • Department of Pathophysiology and Transplantation
      • • Department of Internal Medicine
      • • Istituto di Scienze Dermatologiche
      Milano, Lombardy, Italy
  • 2007
    • Azienda Ospedaliera della Provincia di Lecco
      Lecco, Lombardy, Italy
  • 2005
    • Ospedale Luigi Sacco
      Milano, Lombardy, Italy
  • 1999–2004
    • Ospedale di San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico
      Milano, Lombardy, Italy
  • 2001–2002
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
    • Ospedale Maggiore Carlo Alberto Pizzardi di Bologna
      Bolonia, Emilia-Romagna, Italy
  • 2000–2002
    • Ospedale Maggiore di Lodi
      Lodi, Lombardy, Italy
    • Ospedale Valduce-Como
      Como, Lombardy, Italy
  • 1995–1999
    • Istituto Nazionale Tumori "Fondazione Pascale"
      Napoli, Campania, Italy
    • University of Florence
      Florens, Tuscany, Italy
  • 1998
    • INO - Istituto Nazionale di Ottica
      Florens, Tuscany, Italy
    • Foundation of the Carlo Besta Neurological Institute
      Milano, Lombardy, Italy
  • 1985
    • University of Padova
      Padua, Veneto, Italy