Patients with hereditary hemochromatosis (HH), a disease characterized by a progressive iron overload that is responsible for all of its clinical manifestations, are at high risk of developing liver cancer. 1-3 It has been suggested that iron plays a key role in the occurrence of hepatic cancer although, in most cases, it develops several years after iron depletion. [4][5][6] The possible role of iron as a factor facilitating the development of liver cancer has been also suggested by the finding of increased iron content in the non-neoplastic livers of non-HH patients undergoing liver transplantation for hepatocellular carcinoma (HCC). 7 It has long been debated whether excess iron also facilitates the occurrence of extrahepatic cancers in patients with or without HH. In comparison with the general population, a significantly higher risk of esophageal cancer and skin melanoma has been found in Danish HH patients, 8 and of lung and intestinal cancer in a series of English HH patients 9 ; however, no increased risk of extrahepatic cancer was found in Australian HH patients against those with chronic liver diseases of different etiology. 10 In addition, an increased risk of colorectal and gastric cancers and hematologic malignancies was found in a large series of subjects heterozygous for HH. 11 To verify whether excess iron facilitates the development of liver and nonliver cancers, we prospectively followed 230 HH patients and compared the cancer development rate with that observed in a group of patients with histologically proven non-iron-related chronic liver disease (CLD), matched by sex, age, duration of follow-up, and the severity of the clinical findings. PATIENTS AND METHODS PatientsTwo hundred thirty consecutive patients with HH and all consecutive patients with non-iron-related CLD attending our outpatient liver unit were enrolled in the study between January 1975 and December 1996 and were prospectively followed-up until December 1998 (censoring date). Each HH patient was matched individually to a control case according to age (Ϯ5 years), sex, duration of follow-up (Ϯ5 years), and the severity of liver disease.Hereditary Hemochromatosis Group. The diagnosis of HH was based on standard criteria including exclusion of known causes of iron overload, hepatic iron index (liver iron concentration/age) greater than 1.9, iron removed by weekly phlebotomy to reach the depletion greater than 5 g in men and greater than 3 g in women, and presence of a gradient of liver siderosis from periportal hepatocytes to centrolobular veins. 12 Furthermore, genetic studies of HFE mutations were performed in 200 patients: 62% were homozygotes and 6% heterozygotes for the C282Y mutation; 4% were compound heterozygotes for C282Y and H63D mutations, and 28% carried a wildtype HFE genotype. In Table 1 we report the baseline transferrin saturation percentage, serum ferritin, hepatic iron index, and the amount of iron removed to reach iron depletion of HH patients

In patients with Crohn disease, the frequency of GD is significantly higher than that reported in the general population with comparable characteristics (z = 5.04, P<.001). Age; site of disease at diagnosis; and the history, number, and site of bowel resections are independently associated with GD.

No abstract

No abstract

The diagnostic accuracy of the FDA, PDAI, and computer-assisted AUS imaging was good in assessing perianal disease activity in patients with CD. The agreement between the techniques was fair to moderate. Overall accuracy can be increased by combining the FDA or PDAI with AUS.

Inflammatory bowel diseases are chronic conditions of unknown etiology, showing a growing incidence and prevalence in several countries, including Italy. Although the etiology of Crohn's disease and ulcerative colitis is unknown, due to the current knowledge regarding their pathogenesis, effective treatment strategies have been developed. Several guidelines are available regarding the efficacy and safety of available drug treatments for inflammatory bowel diseases. Nevertheless, national guidelines provide additional information adapted to local feasibility, costs and legal issues related to the use of the same drugs. These observations prompted the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) to establish Italian guidelines on the safety of currently available treatments for Crohn's disease and ulcerative colitis. These guidelines discuss the use of aminosalicylates, systemic and low bioavailability corticosteroids, antibiotics (metronidazole, ciprofloxacin, rifaximin), thiopurines, methotrexate, cyclosporine A, TNFα antagonists, vedolizumab, and combination therapies. These guidelines are based on current knowledge derived from evidence-based medicine coupled with clinical experience of a national working group.

Anal ultrasound can be used to assess fistula track activity in patients with Crohn's disease. The diagnostic performance of the technique can be improved to values comparable with those of magnetic resonance imaging by using a computer-assisted evaluation of the anal ultrasound images.

Intersphincteric abscesses frequently cause perianal symptoms in patients with CD, and their clinical outcomes vary from rapidly progressive inflammation to a benign self-limiting course. The favorable outcome observed in some patients supports a first-line conservative approach to the condition.