About one-third of Greek IBD patients developed at least one EIM. Of those, more than one-third had their EIM diagnosed before IBD, and in about two-thirds it was related to disease activity. EIMs were more frequently present in females and patients with extensive UC in multivariate analysis.

We read with great interest the case report by Bartko and colleagues (1) concerning a patient with osteomalacia due to longstanding hypophosphatemia after long-term intravenous (iv) iron administration. We would like to add our experience regarding a similar case of a male patient with Hirschsprung disease suffering from severe hypophosphatemia due to continuous iv iron administration. A 31-year-old man with extensive Hirschsprung disease (involving the colon and the distal one-third of ileum) was referred to our department suffering from insufficiency fractures and severe hypophosphatemia. Disease onset was on the second day after birth with meconium ileus. By the age of 2 years, he underwent near total colectomy and excision of the distal one-third of the ileum by the Duhamel retrorectal transanal technique. Since then, he suffered from mild iron-deficiency anemia (IDA) and B12 and vitamin D deficiency, managed with oral iron treatment (OIT) and B12 and D2 im injections. Serum phosphate levels were within normal range (1.065 to 1.227 mmol/L). At the age of 26 years, IDA became refractory to OIT because of multiple bleeding ulcers at the site of rectal anastomosis. At that time, monthly ferric carboxymaltose (FCM) iv injections were administered for the management of IDA along with occasional need for blood transfusions. At the age of 29 years, he suffered multiple insufficiency fractures (4th left metatarsal and bilateral rib fractures). Laboratory evaluations performed on several occasions revealed severe hypophosphatemia (as low as 0.355 mmol/L) and secondary hyperparathyroidism. At presentation, the patient had diffuse skeletal pain, gait disturbance, and progressive loss of mobility. Laboratory evaluation revealed severe hypophosphatemia (0.419 mmol/L), mild hypocalcemia (2.09 mmol/L), and secondary hyperparathyroidism (parathyroid hormone [PTH] 104.8 pg/mL). 25 (OH) D levels were normal (77.25 nmol/L), whereas 1,25 (OH) 2 D levels were at the low normal level (24 pg/mL). Urinary calcium excretion was low (1.28 mmol/24 hr), whereas phosphate excretion was elevated (32.16 mmol/24 hr, tubular maximum reabsorption of phosphate to glomerular filtration rate [TmP/GFR] 0.2827 mmol/L [reference range 1.00-1.35]; Table 1). Intact FGF-23 level (Kainos Laboratories, Inc., Tokyo, Japan) was elevated (96 pg/mL [reference range 10-50] (2) ). Dual-energy X-ray absorptiometry (DXA) revealed a low BMD at the lumbar spine (LS) (0.92 mg/cm 2 , Z-score -2.7) and the femoral neck (FN) (0.725, Z-score -2.1). These results pointed to a combined defect: FGF-23 mediated hypophosphatemia due to FCM iv injections, leading to renal phosphate wasting and low calcitriol levels, and calcium and phosphate malabsorption due to low calcitriol and short bowel syndrome. Secondary hyperparathyroidism amplified phosphate wasting.The patient was treated with calcium citrate (500 mg tid) and alphacalcidol (1 mcg bid), was instructed to increase milk intake, and switched to oral iron therapy (ferric hydroxide polymaltose). He was referred to a te...

Background and aims This study aimed to compare real-world clinical effectiveness and safety of vedolizumab, an α4β7-integrin inhibitor, and anti-tumour necrosis factor-α (anti-TNFα) agents in biologic-naïve ulcerative colitis (UC) and Crohn’s disease (CD) patients. Methods This was a 24-month retrospective medical chart study in adult UC and CD patients treated with vedolizumab or anti-TNFα in Canada, Greece and the United States. Inverse probability weighting was used to account for differences between groups. Primary outcomes were cumulative rates of clinical effectiveness (clinical response, clinical remission, mucosal healing) and incidence rates of serious adverse events (SAEs) and serious infections (SIs). Secondary outcomes included cumulative rates of treatment persistence (patients who did not discontinue index treatment during follow-up) and dose escalation and incidence rates of disease exacerbations and disease-related surgeries. Adjusted analyses were performed using inverse probability weighting. Results A total of 1095 patients (604 UC, 491 CD) were included. By 24 months, rates of clinical effectiveness were similar between groups, but incidence rates of SAEs (HR=0.42 [0.28-0.62]) and SIs (HR=0.40 [0.19-0.85]) were significantly lower in vedolizumab vs anti-TNFα patients. Rates of treatment persistence (p<0.01) by 24 months were higher in vedolizumab patients with UC. Incidence rates of disease exacerbations were lower in vedolizumab patients with UC (HR=0.58 [0.45-0.76]). Other outcomes did not significantly differ between groups. Conclusion In this real-world setting, first-line biologic therapy in biologic-naïve patients with UC and CD demonstrated that vedolizumab and anti-TNFα treatments were equally effective at controlling disease symptoms, but vedolizumab has a more favourable safety profile.

The Hellenic Society of Gastroenterology recently organized the "Hellenic consensus on Helicobacter pylori (H. pylori) infection". The aim of this publication is to report the guidelines in order to aid the national gastroenterology community in the management of H. pylori infection. Forty-one delegates from all Greek regions, including gastroenterologists, pathologists, clinical microbiologists, epidemiologists and basic scientists, were invited to this meeting. The participants were allocated to 1 of the 4 main topics of the meeting: i.e., H. pylori diagnosis and association with diseases; H. pylori and gastric cancer; H. pylori and extragastric associated disorders; and H. pylori treatment. The results of each subgroup were submitted to a final consensus vote that included all participants. Relevant data based on international and Greek publications were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. The cutoff level of 70% was considered as acceptance for the final statement. It is hoped that the recommendations and conclusions of this report will guide Greek doctors in their daily practice concerning the management of H. pylori infection.

Pregnancy in women with liver cirrhosis is an infrequent situation. In general the incidence of cirrhosis in pregnancy is very low and it is estimated approximately about 1 in 5,950 pregnancies. We report a descriptive management of pregnancy in a woman suffering from chronic viral hepatitis B with D and C coinfection exacerbated finally to severe cirrhosis of the liver. Caesarean section was performed giving birth to a viable male infant. Two months after the operation the patient underwent a liver transplantation with good outcome. Management of such severe cases requires a multidisciplinary medical approach. Data regarding cirrhosis caused by chronic viral agents in pregnancy are limited.

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Background Anemia is a common extraintestinal manifestation of Inflammatory Bowel Disease (IBD) affecting negatively the patients’ quality of life. The aim of this study was to determine the frequency and real-life management of anemia in IBD patients in Greece. Methods This study was conducted in 17 Greek IBD referral centers. Demographic, clinical, laboratory, IBD and anemia treatment data were collected and analyzed retrospectively. Results A total of 1394 IBD patients [560 ulcerative colitis (UC), 834 Crohn’s disease (CD)] were enrolled. Anemia at any time was reported in 687 (49.3%) patients of whom 413 (29.6%) had episodic and 274 (19.7%) had recurrent/persistent anemia. Anemia was diagnosed before IBD in 45 (6.5%), along with IBD in 269 (39.2%) and after IBD in 373 (54.3%) patients. In the multivariate analysis the presence of extraintestinal manifestations (p = 0.0008), IBD duration (p = 0.026), IBD related surgeries and hospitalizations (p = 0.026 and p = 0.004 accordingly) were risk factors of recurrent/persistent anemia. Serum ferritin was measured in 839 (60.2%) IBD patients. Among anemic patients, 535 (77.9%) received treatment. Iron supplementation was administered in 485 (90.6%) patients, oral in 142 (29.3%) and intravenous in 393 (81%). Conclusions The frequency of anemia in IBD patients, followed at Greek referral centers, is approximately 50%. Development of recurrent/persistent anemia may be observed in 20% of cases and is independently associated with the presence of extraintestinal manifestations, IBD duration, IBD related surgeries and hospitalizations. Anemia treatment is administered in up to $$4/5$$ 4 / 5 of anemia IBD patients with the majority of them receiving iron intravenously.

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