M Zippi

Azienda Ospedaliera Sandro Pertini Roma, Roma, Latium, Italy

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Publications (54)98.49 Total impact

  • P Crispino · R Pica · H Unim · M Rivera · C Cassieri · M Zippi · P Paoluzi
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    ABSTRACT: Mesalazine or Beclomethasone dipropionate (BDP) enema have been shown effective in treatment of distal active ulcerative colitis (UC). This study was aimed to determine whether the combination of topical mesalazine and BDP is superior to topical mesalazine or BDP used alone in patients with distal active UC. PATIENTS AND METHODS: One-hundred and twenty patients with clinical, endoscopic and histological diagnosis of distal active UC were randomly assigned to a regimen with mesalazine tablets 2.4 g/day associated to either mesalazine enema 4 g/day (group A, n=40), BDP 3 mg/60 ml every day (group B, n=40) or the combination treatment with the two compounds in a single administration (group C, n=40) for eight weeks. After four weeks of treatment all patients underwent clinical controls but only 109 patients returned back for clinical, endoscopic and histological controls at the end of the treatment period. After eight weeks, complete remission rates were of 52%, 47% and 65% respectively, in group A, B and C. From baseline to 4 and 8 weeks the CAI score decreased significantly in all the three groups (p < 0.0001). All the three combinations achieved equivalent results in terms of symptoms in inducing symptoms relief and mucosa healing in distally active UC.
    08/2015; 19(15):2830-2837.
  • La Clinica terapeutica 03/2015; 166(1):43-44. · 0.33 Impact Factor
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    ABSTRACT: To investigate prevalence, type and time of onset of extraintestinal manifestations (EIMs) in a series of Italian inflammatory bowel disease (IBD) patients. Data of 811 IBD consecutive patients, first referred to our Centre from 2000 to 2011, were retrospectively evaluated. Eight hundred and eleven IBD patients (437 M, 374 F) were studied: 595 ulcerative colitis (UC) (73.4%) and 216 Crohn's disease (CD) (26.6%). Among these, 329 (40.6%) showed EIMs: 210 UC (35.3%) and 119 CD (55.1%) (P < 0.0001). Considering the time of the diagnosis of IBD, 37 EIMs (11.2%) were developed before, 229 (69.6%) after and 63 (19.2%) were simultaneous. The type of EIM were as follows: 240 musculoskeletal (29.6%), in 72 CD patients and in 168 UC (P < 0.0001); 47 mucocutaneous (5.8%), in 26 CD and in 21 UC (P = 0.0049); 26 ocular (3.2%), in 16 CD and in 10 UC (CD 7.4% vs UC 1.7%, P = 0.0093); 6 hepatobiliary (0.8%); 10 endocrinological (1.2%). In particular, with regards to the involvement of the musculoskeletal system, arthritis Type 1 was found in 41 CD (19%) and in 61 UC (10.2%) (P = 0.0012) and Type 2 in 25 CD (11.6%) and in 100 UC (16.8%) (P = 0.0012). Mucocutaneous manifestations, arthritis Type 1 and uveitis were significantly more frequent in CD than UC. The complications of the musculoskeletal system were the mostly observed ones, often with symptoms more severe than intestinal ones, confirming the need for close cooperation with rheumatologists.
    World Journal of Gastroenterology 12/2014; 20(46):17463-7. DOI:10.3748/wjg.v20.i46.17463 · 2.37 Impact Factor
  • La Clinica terapeutica 11/2014; 165(6):313-4. · 0.33 Impact Factor
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    ABSTRACT: Background: Pancreas divisum (PD) is a common anatomical variant of the pancreatic duct system. Only a little percentage of patients with this altered anatomy develop symptoms: acute recurrent pancreatitis (ARP), chronic pancreatitis (CP) and pancreatic-type pain alone. These have been supposed to arise from an obstruction to outflow of the pancreatic dorsal duct due to a stenosis of the minor papilla. Endoscopic sphincterotomy of the minor papilla (MiES) can be considered an effective treatment for patients with PD and ARP supported by stenosis or obstruction of the minor papilla. On the other hand, the access through the minor papilla is essential for therapeutic pancreatic endoscopy in patients with PD and CP, but the effectiveness of MiES in these patients is extremely controversial. Materials and methods: Aim of this brief review has been to evaluate the short and long-term effects of endoscopic pancreatic interventions in patients affected by symptomatic PD who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic sphincterotomy of the minor papilla (MiES). The main literature database was Medline (1966-2013). Results: Data come from a personal overview of articles emerging from the same search strategy. Conclusions: Nowadays, when endoscopic pancreatic drainage is indicated in patient with symptomatic PD, access through the minor papilla (MiP) is required. Therapeutic endoscopic interventions provide less invasive alternatives to the surgical approach.
    La Clinica terapeutica 07/2014; 165(4):e312-e316. DOI:10.7417/CT.2014.1748 · 0.33 Impact Factor
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    ABSTRACT: Background and aim: Periampullary diverticula (PAD) are found in 9-32% of patients who undergo endoscopic retrograde cholangiopancreatography (ERCP). PAD are acquired lesions which are rare in patients <40 years, but increasing with age. Several endoscopic studies have revealed an association between PAD and common bile duct (CBD) stones. The presence of a papilla located in the diverticula is also frequent (6.8-54.9%) and represents a restrictive factor for successful cannulation. Materials and methods: A retrospective analysis has been made of data related to the patients with PAD treated at our GI Unit (small center with low case volume), who underwent ERCP in the period 1st January 2010 to 31st March 2014. For each patient were analyzed data regarding sex, age at diagnosis, indication to ERCP, cannulation rate, endoscopic treatment and complications. PAD were classified in 3 different types according to the position of the major papilla. Results: A total of 647 ERCPs have been performed of which 77 (16.5%) in pts with PAD (48 F, 29 M, mean age: 78.3 years; range: 48-95). PAD type I (inside the diverticulum) were found in 22 pts (28.6 %), Type II (in the margin of the diverticulum or between two PADs) in 36 pts (46.7 %) of which 12 cases between two PADs, type III (near the diverticulm) in 19 pts (24.7 %). The indication for ERCP were: 72 CBD stones (93.5%), 3 cholangiocarcinoma (3.9%) and 2 pancreatic head cancer (2.6%). In cases of difficult cannulation, precut was performed in 12 pts (15.6%). Deep CBD cannulation and endoscopic sphincterotomy (ES) was achieved in 70 cases (90.9%). The other 7 case of failure were all in patients with CBD stones. Complete clearance of CBD stones was achieved in 57 patients (87.7%) (57/65 ERCP/ES). Stent placement was necessary in 8 cases (12.3%) (8/65 ERCP/ES), due to multiple large stones. The adverse events related to ERCP/ES included 4 intraprocedural bleeding (5.7%) (4/70 ERCP/ES) and 1 mild pancreatitis (1.4%) (1/70 ERCP/ES), all managed conservatively. Conclusions: Our data show that ERCP is a safe procedure also in patients with PAD, with a good success rate and low complications.
    La Clinica terapeutica 07/2014; 165(4):e291-e294. DOI:10.7417/CT.2014.1745 · 0.33 Impact Factor
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    ABSTRACT: Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence, and manifestations. Simple hepatic cysts are considered nonparasitic ones. These are a result of congenital anomalies of the biliary system, and these may be single or multiple. Generally, hepatic cysts are incidentally found during occasional laparotomy or laparoscopy, necropsy, and even during routine ultrasound or computerized tomography (CT) scan. Nowadays, with improving diagnostic techniques, hepatic cysts are becoming more common. Generally these lesions are asymptomatic. However, if they grow, they may become symptomatic. Symptoms depend on the size and location. When symptoms developed, these must be treated. Compressive complications due to local "liver mass" effect include: portal hypertension, edema due to caval compression, jaundice and arrhythmia and duodenal obstruction. Gastric extrinsic compression by liver cysts has been poorly described. Herein, we present a case of a female in whom percutaneous drainage of a large simple hepatic cysts not complicated was performed in order to reduce signs of gastric compression.
    La Clinica terapeutica 04/2014; 165(2):e170-3. DOI:10.7471/CT.2014.1704 · 0.33 Impact Factor
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    ABSTRACT: In order to ensure enteral feeding, placement of a percutaneous endoscopic gastrostomy (PEG) is considered a standard care for patients with oropharyngeal malignancies. Benign pneumoperitoneum is a complication of PEG feeding tube placement and it is usually an incidental finding that arises, generally, immediately following the procedure. We report a case of a benign pneumoperitoneum, developed 48 hours after the procedure, which was treated conservatively.
    La Clinica terapeutica 03/2014; 165(1):e76-8. DOI:10.7417/CT.2014.1677 · 0.33 Impact Factor
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    ABSTRACT: Eosinophilic esophagitis (EoE) is the most common form of gastrointestinal disorders associated with eosinophilia. Typically, an inappropriate accumulation of eosinophils is found in the esophageal mucosa. EoE can be well managed and treated with several options that include an elimination diet, drug therapy (oral and topical steroids) and esophageal dilatations. We herein, report a case of a 49-year-old male affected by EoE associated to chest pain, treated with proton pump inhibitor without clinical response. The patient suffered from long lasting postprandial fullness and gastroesophageal reflux disease-like symptoms. He had a history of episodic asthmatic attacks and allergic rhinitis but had not dysphagia or food impaction. The patient recovered completely after an adequate treatment.
    La Clinica terapeutica 03/2014; 165(1):e70-2. · 0.33 Impact Factor
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    ABSTRACT: Approximately one third of patients with ulcerative colitis (UC) require surgery. Aim of this study was to assess the quality of life (QoL) of UC patients who have undergone surgery with ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA) compared to UC patients not operated. Fifty consecutive UC patients for each group observed between 1988-2010 were included. To all patients was administered a self completed questionnaire with four different scores: intestinal symptoms (IS), systemic symptoms (SS), emotional function (EF), social function (SF) and an overall QoL score. Overall QoL score and three dimensions (SS, EF, SF) resulted not significantly different in the three groups, except for IS that resulted worst in the IRA-Group. According to the activity of disease it appeared that UC and IRA patients with mild activity had an overall QoL score similar to patients with complicated IPAA. A higher statistically different score of overall QoL was observed in patients with UC and IRA with moderate/severe disease. Results of the study demonstrate that overall QoL score is poorer in patients with UC and IRA with mild activity and in patients with complicated IPAA and is worst in patients with UC and IRA with moderate/severe activity.
    European review for medical and pharmacological sciences 03/2014; 18(5):693-8. DOI:10.1016/S1873-9946(12)60378-X · 1.21 Impact Factor
  • Digestive and Liver Disease 03/2014; 46:S75. DOI:10.1016/S1590-8658(14)60218-8 · 2.96 Impact Factor
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    ABSTRACT: Azathioprine (AZA) and 6-mercaptopurine (6-MP), purine analogues, are the immunosuppressant drugs most frequently used for inducing and maintaining remission in inflammatory bowel disease (IBD). The occurrence of adverse effects is a major drawback in the use of these drugs, and short- and long-term toxicity represent a major limitation to their use. The present study investigated the prevalence, type and time of onset of AZA-related adverse events, in a cohort of IBD patients in a single referral Centre. The records of consecutive IBD outpatients, referred to our Institution between 1987-2009, were retrospectively evaluated. We reviewed 2014 patients, in whom AZA was prescribed in 302 of them, 139 (46%) with ulcerative colitis (UC) and 163 (54%) with Crohn's disease (CD). Side-effects were complained by 98 (32.4%) out of 302 patients, 50 UC and 48 CD, (36% UC vs 29.4% CD, p = 0.26). In 20 (20.4%) patients, 11 UC and 9 CD, side-effects recovered after dosage reduction whilst in 78 (79.6%), 39 UC and 39 CD, the treatment was discontinued (dose-dependent side-effects in 42 patients and dose-independent in 36). Overall, side-effects were observed after a mean period of 14.5±7.8 months (range 0.5-123) of AZA treatment. The majority (76%) of the dose-dependent adverse events were reported between 12-18 months after the beginning of treatment. The prevalence of side effects leading to withdrawal of AZA treatment, in our series of Italian patients, was higher respect to data reported in the literature (25.8%).
    European review for medical and pharmacological sciences 02/2014; 18(2):165-70. · 1.21 Impact Factor
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    ABSTRACT: Background: Choledocholithiasis is increasing in elderly subjects. The introduction of endoscopic retrograde cholangiopancreatography with biliary sphincterotomy has almost replaced surgery in the treatment of this condition. The aim of the present study was to evaluate the rates of successful clearance of common bile duct stones and the endoscopic techniques used in a population aged 75 years or older compared with those in a younger age group. Materials and methods: A retrospective analysis was made of data related patients who underwent endoscopic retrograde cholangiopancreatography for choledocolithiasis in the period 2010-2011. For all patients, factors such as sex, age at diagnosis, endoscopic treatment (stone extraction using baskets and balloon, mechanical lithotripsy and balloon dilatation of the ampulla, placement of a stent or a naso-biliary tube) and need of surgery were analysed. Two groups of patients were identified: patients aged <75 years (Group A) and patients aged ≥75 years (Group B). For the statistical analysis Mann-Whitney test and Fischer's Exact test were used. Results: A total of 234 patients were enrolled in the study (94 in Group A, 140 in Group B). No statistically significant differences were observed as far concerns sex, previous cholecystectomy, gallbladder stones and periampullary diverticula, but only for common bile duct dilatation. Complete clearance of common bile duct stones was achieved in 230 patients (97.5%). Conclusions: The present data are in keeping with those presented in the literature, which confirm that endoscopic retrograde cholangiopancreatography is a safe and effective procedure also in older patients.
    La Clinica terapeutica 11/2013; 164(5):e353-8. DOI:10.7417/CT.2013.1612 · 0.33 Impact Factor
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    ABSTRACT: Pouchitis is not a rare complication that develops after an ileal-pouch anastomosis, performed after colectomy in patients refractory to treatment or with complicated ulcerative colitis. This condition may become chronic and unresponsive to medical therapies, including corticosteroids, antibiotics and probiotics. The advent of biological therapies (tumor necrosis factor-α inhibitors) has changed the course of these complications. In particular, in these cases, infliximab (IFX) may represent a safe and effective therapy in order to avoid the subsequent operation for a permanent ileostomy. This article reviews the therapeutic effects of one of the most widely used anti-tumor necrosis factor-α molecules, IFX, for the treatment of complicated pouchitis (refractory to conventional treatment and/or fistulizing).
    09/2013; 1(6):191-196. DOI:10.12998/wjcc.v1.i6.191
  • Maddalena Zippi · Roberta Pica · Daniela De Nitto · Paolo Paoluzi
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    ABSTRACT: Ulcerative colitis and Crohn's disease are the two forms of inflammatory bowel disease (IBD). The advent of biological drugs has significantly changed the management of these conditions. Skin manifestations are not uncommon in IBD. Among the reactive lesions (immune-mediated extraintestinal manifestations), erythema nodosum (EN) and pyoderma gangrenosum (PG) are the two major cutaneous ills associated with IBD, while psoriasis is the dermatological comorbidity disease observed more often. In particular, in the last few years, anti-tumor necrosis factor (TNF)-α agents have been successfully used to treat psoriasis, especially these kinds of lesions that may occur during the treatment with biological therapies. The entity of the paradoxical manifestations has been relatively under reported as most lesions are limited and a causal relationship with the treatment is often poorly understood. The reason for this apparent side-effect of the therapy still remains unclear. Although side effects may occur, their clinical benefits are undoubted. This article reviews the therapeutic effects of the two most widely used anti-TNF-α molecules, infliximab (a fusion protein dimer of the human TNF-α receptor) and adalimumab (a fully human monoclonal antibody to TNF-α), for the treatment of the major cutaneous manifestations associated with IBD (EN, PG and psoriasis).
    05/2013; 1(2):74-78. DOI:10.12998/wjcc.v1.i2.74
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    ABSTRACT: To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) performed for common bile duct (CBD) stones. From a computer database, we retrospectively analyzed the data relating to EBD performed in patients at the gastrointestinal unit of the Sandro Pertini Hospital of Rome (small center with low case volume) who underwent endoscopic retrograde cholangiopancreatography (ERCP) for CBD from January 1, 2010 to February 29, 2012. All patients had a proven diagnosis of CBD stones studied with echography, RMN-cholangiography and, when necessary, with computed tomography of the abdomen (for example, in cases with pace-makers). Prophylactic therapies, with gabexate mesilate 24 h before the procedure and with an antibiotic (ceftriaxone 2 g) 1 h before, were administered in all patients. The duodenum was intubated with a side-viewing endoscope under deep sedation with intravenous midazolam and propofol. The patients were placed in the supine position in almost all cases. EBD of the ampulla was performed under endoscopic and fluoroscopic guidance with a balloon through the scope (Hercules, wireguided balloon(®), Cook Ireland Ltd. and CRE(®), Microvasive, Boston Scientific Co., Natick, MA, United States). A total of 14 patients (9 female, 5 male; mean age of 73 years; range 57-82 years) were enrolled in the study, in whom a total of 15 EBDs were performed. All patients underwent minor endoscopic sphincterotomy (ES) prior to the EBD. The size of balloon insufflation depended on stone size and CBD dilation and this was performed until it reached 16 mm in diameter. EBD was performed under endoscopic and fluoroscopic guidance. The balloon was gradually filled with diluted contrast agent and was maintained inflated in position for 45 to 60 s before deflation and removal. The need for precutting the major papilla was 21.4%. In one patient (an 81-year-old), EBD was performed in a Billroth II. Periampullary diverticula were found only in a 74-year-old female. The adverse event related to the procedures (ERCP + ES) was only an intra procedural bleeding (6.6%) that occurred after ES and was treated immediately with adrenaline sclerotherapy. No postoperative complications were reported. With the current endoscopic techniques, very few patients with choledocholithiasis require surgery. EBD is an efficacious and safe procedure.
    04/2013; 1(1):19-24. DOI:10.12998/wjcc.v1.i1.19
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    ABSTRACT: Schwannoma is a tumor originating from the Schwann cells. Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and, in particular, rectal schwannomas are extremely rare. In fact, it is well established that schwannomas appear more frequently in the stomach and in the small intestine, while location in the colon or in the rectum is uncommon. Reading the literature, only few cases of rectal schwannoma have been reported. Their diagnosis is confirmed by the immunohistochemical panel (S-100 protein). When these tumors are located in the colon and in the rectum, radical excision with wide margins is mandatory, due to their tendency to recur locally or become malignant, if left untreated. In the present study, we describe a case of a rectal schwannoma occured in a 72-year-old man, presented as a small polypoid lesion, which was successfully removed in toto by hot-biopsy, during the same endoscopy, due to the dimensons. No recurrence of the lesion was observed after 6 mo of follow-up.
    04/2013; 1(1):49-51. DOI:10.12998/wjcc.v1.i1.49
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    ABSTRACT: One of the most frequent complications of endoscopic sphincterotomy (ES) is bleeding. When post-ES bleeding does not respond to the use of typical endoscopic therapy, the only alternative is angiography or surgery. A 82-year-old female was admitted for jaundice. A RMN-cholangiography revealed multiple stones in the common bile duct (CBD). She underwent endoscopic retrograde cholangiopancreatography (ERCP). The papilla major was located between two large periampullary diverticula. During the ES, a severe bleeding was observed from the upper part of the biliary cut. Several methods of hemostasis (injection of adrenaline, thermal methods and balloon tamponate) were performed without efficacy. A partially covered metallic stent was placed across the biliary orifice, in order to compress mechanically the bleeding site achiving the hemostasis. Clin Ter 2013; 164(1):e27-29. doi: 10.7417/CT.2013.1517.
    La Clinica terapeutica 03/2013; 164(1):e27-9. · 0.33 Impact Factor
  • Journal of Crohn s and Colitis 02/2013; 7:S178-S179. DOI:10.1016/S1873-9946(13)60442-0 · 6.23 Impact Factor
  • Journal of Crohn s and Colitis 02/2013; 7:S251-S252. DOI:10.1016/S1873-9946(13)60623-6 · 6.23 Impact Factor