Serum level of lactadherin (MFGE8) in inflamatory bowel disease

OBJECTIVE

Evaluation of serum lactadherin level, its correlation with disease activity and certain biochemical parameters in IBD patients.

METHODS

The study involved adult IBD patients, comprising 50 with ulcerative colitis (UC), 68 with Crohn's disease (CD), and 29 healthy controls.

RESULTS

The MFGE8 median concentration was significantly higher in UC versus controls (1914.54 vs. 1392.21; p = 0.017), but not in CD. The median MFGE8 levels in UC and CD patient groups didn't significantly differ. There was a significant inverse correlation between MFGE8 and CRP (r = -0.283; p = 0.044) and fibrinogen (r = -0.362, p = 0.017) in UC. In active UC, MFGE8 median concentration was higher versus controls (1974.36 vs. 1392.21; p = 0.04) and negatively correlated with CRP (r = -0.482; p = 0.005), WBC (r = -0.391; p = 0.027), and fibrinogen (r = -0.473; p = 0.015). Inactive UC showed negative correlation only with fibrinogen (r = -0.567; p = 0.018). No correlations were found with disease activity measured using appropriate scales, age, BMI, or gender.

CONCLUSIONS

Active UC patients show higher MFGE8 levels. These increase inversely with inflammatory markers (CRP, WBC, fibrinogen) in active UC, but not in CD.

Diagnostic and therapeutic recommendations on Helicobacter pylori infection. Recommendations of the Working Group of the Polish Society of Gastroenterology

Helicobacter pylori remains a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. These guidelines constitute an update of the previous "Recommendations on the diagnosis and management of Helicobacter pylori infection" issued in 2014. They have been developed by a Task Force organized by the Governing Board of the Polish Society of Gastroenterology. They discuss, with particular emphasis on new scientific data covering papers published since 2014: the epidemiology, clinical presentation, diagnostic principles and criteria for the diagnosis, and recommendations for the treatment of H. pylori infection. The guidelines in particular determine which patients need to be tested and treated for infection. The Task Force also discussed recommended treatment algorithms. Accordingly, a combination of available evidence and consensus-based expert opinion were used to develop these best practice advice statements. It is worth noting that guidelines are not mandatory to implement but they offer advice for pragmatic, relevant and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.

Ustekinumab in the treatment of acute disseminated pyoderma gangrenosum in a patient with Crohn's disease

Pyoderma gangrenosum (PG) is an auto-inflammatory dermatosis characterized by lesions that often cause ulcers. We present a case of successful ustekinumab treatment for acute general PG in a 31-year-old woman with coexisting Crohn's disease (CD). For a month, the patient suffered from skin ulcers, two of them deep and necrotic; a histopathological examination revealed PG. Treatment included: methylprednisolone, azathioprine, betamethasone, gentamicin and zincic ointments, antiseptic compresses, and adalimumab therapy. Due to resistance to the implemented treatment, the patient was enrolled in a clinical trial that included the administration of an anti-cytokines drug, ustekinumab. Subsequently, a significant reduction was observed in the severity of symptoms of PG with no relapse. The use of ustekinumab in patients with PG who have an inadequate response to current treatment or cannot receive first-line treatment can be considered. This applies especially to patients with accompanying autoimmune diseases such as CD.

The significance of nutritional strategies in patients with inflammatory bowel disease in the context of malnutrition and the development of malnourished obesity

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, despite the increasing incidence, still do not have a specific etiology. Diet seems to be an important factor, modifying the occurrence of the disease and its course. Diet can affect the symptoms of IBD both directly, e.g., by alleviating diarrhea, bloating and constipation, and indirectly by shaping the microbiota. Bacterial metabolites produced under the influence of supplied nutrients may contribute to the modulation of pro- and anti-inflammatory pathways, depending on the diet used. So far, IBD has been associated with weight loss and malnutrition. In recent years, a trend of sarcopenic obesity with concomitant malnutrition has been observed. The new phenomenon is called malnubesity. This work aims to review the most commonly used diets in IBD in order to evaluate them in terms of alleviating ailments, but also maintaining proper nutritional status and lack of obesity. Low-fiber, low FODMAPs, Mediterranean diet and Crohn's Disease Exclusion Diet diet were considered. We assume that diet is modifiable factor that is related to nutritional status and healthy body weight. In addition, the current knowledge on the relationship between nutrition strategies, obesity and IBD will be demonstrated.

Postprandial effect of gastrointestinal hormones and gastric activity in patients with irritable bowel syndrome

Altered gut regulation, including motor and secretory mechanisms, is characteristic of irritable bowel syndrome (IBS). The severity of postprandial symptoms in IBS patients is associated with discomfort and pain; gas-related symptoms such as bloating and abdominal distension; and abnormal colonic motility. The aim of this study was to assess the postprandial response, i.e., gut peptide secretion and gastric myoelectric activity, in patients with constipation-predominant IBS. The study was conducted on 42 IBS patients (14 males, 28 females, mean age 45.1 ± 15.3 years) and 42 healthy participants (16 males, 26 females, mean age 41.1 ± 8.7 years). The study assessed plasma gut peptide levels (gastrin, CCK-Cholecystokinin, VIP-Vasoactive Intestinal Peptide, ghrelin, insulin) and gastric myoelectric activity obtained from electrogastrography (EGG) in the preprandial and postprandial period (meal-oral nutritional supplement 300 kcal/300 ml). Mean preprandial gastrin and insulin levels were significantly elevated in IBS patients compared to the control group (gastrin: 72.27 ± 26.89 vs. 12.27 ± 4.91 pg/ml; p < 0.00001 and insulin: 15.31 ± 12.92 vs. 8.04 ± 3.21 IU/ml; p = 0.0001), while VIP and ghrelin levels were decreased in IBS patients (VIP: 6.69 ± 4.68 vs. 27.26 ± 21.51 ng/ml; p = 0.0001 and ghrelin: 176.01 ± 88.47 vs. 250.24 ± 84.55 pg/ml; p < 0.0001). A nonsignificant change in the CCK level was observed. IBS patients showed significant changes in postprandial hormone levels compared to the preprandial state-specifically, there were increases in gastrin (p = 0.000), CCK (p < 0.0001), VIP (p < 0.0001), ghrelin (p = 0.000) and insulin (p < 0.0001). Patients with IBS showed reduced preprandial and postprandial normogastria (59.8 ± 22.0 vs. 66.3 ± 20.2%) compared to control values (83.19 ± 16.7%; p < 0.0001 vs. 86.1 ± 9.4%; p < 0.0001). In response to the meal, we did not observe an increase in the percentage of normogastria or the average percentage slow-wave coupling (APSWC) in IBS patients. The postprandial to preprandial power ratio (PR) indicates alterations in gastric contractions; in controls, PR = 2.7, whereas in IBS patients, PR = 1.7, which was significantly lower (p = 0.00009). This ratio reflects a decrease in gastric contractility. Disturbances in the postprandial concentration of gut peptides (gastrin, insulin and ghrelin) in plasma may contribute to abnormal gastric function and consequently intestinal motility, which are manifested in the intensification of clinical symptoms, such as visceral hypersensitivity or irregular bowel movements in IBS patients.

The Importance of Nutritional Aspects in the Assessment of Inflammation and Intestinal Barrier in Patients with Inflammatory Bowel Disease

Intestinal inflammation in inflammatory bowel disease (IBD) is closely linked to nutrition. This study aimed to evaluate associations between nutritional, inflammatory, and intestinal barrier parameters in patients with IBD. We assessed nutritional status, fecal short-chain fatty acid profile, serum cytokine levels, and mRNA expression of enzymes and tight junction proteins in intestinal biopsies obtained from 35 patients, including 11 patients with inactive IBD, 18 patients with active IBD, and six controls. Patients with active IBD were characterized by hypoalbuminemia, fluctuations in body weight, and restriction of fiber-containing foods. In addition, they had significantly reduced levels of isovaleric acid and tended to have lower levels of butyric, acetic, and propionic acids. Patients with active IBD had higher mRNA expression of peroxisome proliferator-activated receptor γ and inducible nitric oxide synthase, and lower mRNA expression of claudin-2 and zonula occludens-1, compared with patients with inactive IBD. Moreover, patients with a body mass index (BMI) of ≥25 kg/m2 had higher median tumor necrosis factor-α levels that those with a lower BMI. We comprehensively evaluated inflammatory parameters in relation to IBD activity and nutritional status. The discrepancies between proinflammatory and anti-inflammatory parameters depending on IBD activity may be related to nutritional factors, including diet and abnormal body weight.

Association between fecal levels of Short-Chain Fatty Acids and serum Pro- and Anti-Inflammatory Cytokines in patients with Inflammatory Bowel Disease

INTRODUCTION

Inflammatory bowel disease (IBD) represents a group of chronic inflammatory disorders characterized by dysbiosis and altered short-chain fatty acid (SCFA) level. The association between individual SCFA levels and cytokine levels is unknown.

OBJECTIVES

We aimed to determine the fecal SCFA levels in patients with IBD in relation to disease severity and the serum levels of pro- and anti-inflammatory cytokines.

PATIENTS AND METHODS

The study included 61 patients with IBD (inactive, 22; active, 39) and 16 controls. Fecal levels of organic acids (acetic, lactic, propionic, butyric, isovaleric, isobutyric, and valeric), serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), IL-17, and IL-22, complete blood count and C-reactive protein (CRP) were measured.

RESULTS

Patients with active IBD had reduced butyric, acetic, valeric, and isovaleric acid levels and elevated lactic acid levels in stool. Hemoglobin levels were positively correlated with the levels of acetic and butyric acids (R = 0.266 and R = 0.346, respectively; P <0.05). In addition, CRP levels were inversely correlated with butyric acid levels (R = -0.573; P <0.05). Higher serum TNF-α levels were observed in patients with active IBD compared with controls (6.64 pg/ml vs 2.05 pg/ml, P <0.05). No relationship was noted between the SCFA profile and cytokine levels.

CONCLUSIONS

The study showed that determination of SCFA levels can be used to evaluate the activity of IBD. The relationship between individual SCFA and cytokine levels seems to be complex and requires further studies.

Association between Fecal Short-Chain Fatty Acid Levels, Diet, and Body Mass Index in Patients with Inflammatory Bowel Disease

Simple Summary

Inflammatory bowel disease (IBD) is a chronic disorder of the gastrointestinal tract associated with gut inflammation and a disturbance in the amount of bacteria living in the human intestines. As a result, there is a reduction in the production of bacterial metabolites, especially short-chain fatty acids (SCFAs), which are formed from dietary fiber. The aim of our study was to assess the relationship between body mass index (BMI), the type of diet used, and changes in fecal SCFA levels in patients with IBD. We enrolled 61 patients with IBD and 16 patients as a control group. We asked all participants about their daily diet, using the simplified FF questionnaire, and measured the levels of SCFA in their stool samples. Our results revealed that underweight subjects had higher levels of isobutyric acid, whereas those with excessive weight had lower level of butyric, isovaleric, and propionic acids. Furthermore, we observed higher levels of valeric acid in controls than in IBD patients. However, we did not observe a relationship between diet habits and fecal SCFA levels. In conclusion, we demonstrated that BMI is associated with SCFA levels in patients with IBD.

Abstract

Disturbances in the production of bacterial metabolites in the intestine have been reported in diseases associated with dysbiosis, such as inflammatory bowel diseases (IBDs) that include two conditions: Crohn disease (CD) and ulcerative colitis (UC). Short-chain fatty acids (SCFAs) are the main dietary-fiber-derived bacterial metabolites associated with the course of intestinal inflammation. In this study, we assessed the relationship between body mass index (BMI), the type of diet used, and changes in fecal SCFA levels in patients with IBD. We performed nutritional assessments using a nutritional questionnaire and determined fecal SCFA levels in 43 patients with UC, 18 patients with CD, and 16 controls. Our results revealed that subjects with a BMI > 24.99 kg/m² had higher levels of isobutyric acid, whereas those with a BMI < 18.5 kg/m² had lower level of butyric, isovaleric, and propionic acids. Furthermore, we observed higher levels of valeric acid in controls than in IBD patients. We did not reveal a relationship between a specific SCFA and the type of diet, but eating habits appear to be related to the observed changes in the SCFA profile depending on BMI. In conclusion, we demonstrated that BMI is associated with SCFA levels in patients with IBD.

The risk of essential fatty acid insufficiency in patients with inflammatory bowel diseases: fatty acid profile of phospholipids in serum and in colon biopsy specimen

INTRODUCTION

The aim of the study was to address the fatty acid (FA) status and its relationship with disease activity in patients with inflammatory bowel disease (IBD).

METHODS

FA levels of the phospholipid fraction in serum and a colon biopsy specimen were measured in 17 patients with IBD.

RESULTS

A negative correlation between the histological activity of inflammation of the disease and the ratio of polyunsaturated FAs/no polyunsaturated FAs was observed. Moreover, the level of that ratio was lower in patients with IBDs as compared to controls.

CONCLUSIONS

The FA profile in serum and in a colon biopsy specimen in patients with IBD is characteristic for essential fatty acid insufficiency.

Serum levels of selected micronutrients in patients with inflammatory bowel disease in clinical remission

INTRODUCTION

Patients with inflammatory bowel disease (IBD) can experience micronutrient deficiency regardless of disease activity and extent.

OBJECTIVES

We aimed to evaluate serum concentrations of selected trace elements in adult patients with IBD in clinical remission with involvement limited to the colon who received immunosuppressive treatment.

PATIENTS AND METHODS

We enrolled 32 patients with IBD (mean [SD] age, 41 [15.2] years) and 30 healthy controls (mean [SD] age, 39.1 [11.8] years). Serum selenium, iron, copper, and zinc levels as well as complete blood count were measured in both groups.

RESULTS

Patients with IBD had lower zinc concentrations than controls (mean [SD], 0.76 [0.13] mg/l vs 0.83 [0.13] mg/l; P = 0.047). No differences were observed for selenium (mean [SD], 0.90 [0.24] μmol/l vs 0.93 [0.19] μmol/l) and copper levels (mean [SD], 1.03 [0.27] mg/l vs 0.97 [0.22] mg/l). Compared with controls, patients with IBD had lower red blood cell count (mean [SD], 4.4 [0.6] 106/μl vs 4.7 [0.4] 106/μl; P = 0.03), hemoglobin (mean [SD], 12.7 [2.2] g/dl vs 14.3 [0.8] g/dl; P = 0.001), and iron levels (mean [SD], 14.2 [9.4] μmol/l vs 23.4 [2.7] μmol/l; P = 0.0001). Patients with IBD showed a positive correlation between selenium and iron (R = 0.499; P = 0.004) as well as selenium and hemoglobin levels (R = 0.579; P = 0.001).

CONCLUSIONS

Patients with IBD, despite maintaining clinical remission, should undergo systematic laboratory test for anemia or micronutrient deficiencies.

Effect of selected personality traits and stress on symptoms of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder diagnosed on the basis of Rome IV criteria. Stress is an important contributor to the development of IBS symptoms, while personality, perceived self-efficacy, resilience, and coping strategies may be indirectly involved in the modulation of the body's response to various stressors. The aim of this study was to assess the effect of selected personality traits and stress with IBS symptoms. We enrolled 129 participants (59 men and 70 women) aged from 18 to 61 years. The study group included 94 patients with IBS, while the control group comprised 35 participants without a diagnosed psychosomatic disorder and chronic comorbidities. Participants were assessed using a self-designed questionnaire as well as the Coping Inventory for Stressful Situations, NEO-Five Factor Inventory, 25-item Resilience Coping Scale (Skala Pomiaru Prężności - SPP-25), and General Self-Efficacy Scale. We observed a significant effect of personality, perceived self-efficacy, resilience, and coping strategies in patients with IBS. Moreover, stress was shown to be associated with disease severity, while the type of a coping strategy was related to the frequency of symptoms. The groups differed in terms of personality traits such as resilience, self-efficacy, extraversion, and neuroticism. Our study confirms the significant effect of personality traits and coping strategies in patients with IBS.

Effect of long-term proton pump inhibitor therapy on complete blood count parameters and selected trace elements: a pilot study

INTRODUCTION

Proton pump inhibitors (PPIs) are widely prescribed for several gastrointestinal conditions, often as long‑term therapy. The effects of term PPI use have not been fully elucidated.

OBJECTIVES

We aimed to determine the association between long‑term PPI use and complete blood count parameters, particularly red blood cell (RBC) count, white blood cell (WBC) count, and hemoglobin concentrations, as well as serum levels of selected micronutrients such as selenium (Se), iron (Fe), copper (Cu), and zinc (Zn).

PATIENTS AND METHODS

We enrolled 37 patients on long‑ term PPI therapy (mean [SD] age, 57.1 [15.4] years) and 30 healthy controls (mean [SD] age, 39.3 [11.8] years). In each group, complete blood count, and serum Fe levels were performed, and serum Cu, Zn, and Se levels were measured using atomic absorption spectrometry.

RESULTS

Red blood cell and WBC counts were lower in the PPI group compared with controls (mean [SD], 4.24 [0.55] ×106/μl vs 4.7 [0.4] ×106/μl; P <0.001 and 6.13 [1.44] ×103/μl vs 7.3 [1.28] ×103/μl; P <0.001, respectively). Hemoglobin and serum Fe concentrations were also lower in the PPI group (mean [SD], 12.5 [1.8] g /dl vs 14.3 [0.8] g /dl; P <0.001 and 16.3 [5.4] μmol/l vs 23.4 [2.7] μmol/l; P <0.001, respectively). Serum Zn and Cu concentrations were higher in PPI users than in controls.

CONCLUSIONS

Long‑term PPI therapy may reduce RBC and WBC counts as well as hemoglobin levels, leading to iron deficiency. It may also aff ect concentrations of some micronutrients, although the underlying mechanism of this association is not fully clear.

Associations between chronotype, sleep disturbances and seasonality with fatigue and inflammatory bowel disease symptoms

Growing number of studies suggests link between circadian rhythms and inflammatory bowel diseases (IBD) manifestation. We hypothesize that: 1) IBD are associated with increased eveningness and sleep disturbances; 2) eveningness and sleep disturbances are related to more severe IBD symptoms. In total, 129 participants were enrolled to this study, divided into three groups: 34 Crohn's disease (CD) patients, 38 ulcerative colitis (UC) patients and 57 healthy controls (HC) group. They all fulfilled a questionnaire, consisting of the Composite Scale of Morningness (CSM), Seasonal Pattern Assessment Questionnaire (SPAQ), Pittsburgh Sleep Quality Index, Inflammatory Bowel Disease Questionnaire (IBDQ) and Multidimensional Fatigue Inventory (MFI). Multiple regression models controlled for age and sex revealed that in CD group higher eveningness measured with CSM was associated with higher general fatigue, physical fatigue, mental fatigue and reduced motivation measured by MFI. Lower CSM morning affect is associated with greater general fatigue, physical fatigue and more reduced activity. Greater seasonality scores are associated with increased physical fatigue and more reduced activity and motivation. Lower sleep quality measured with PSQI is associated with higher physical fatigue and more reduced activity. Correlational analysis revealed that higher seasonality and lower sleep quality are associated with increased systemic and bowel symptoms and decreased emotional and social functions measured with IBDQ. In UC group, eveningness is associated with greater general fatigue, physical fatigue and more reduced activity. Higher CSM morning affect is associated with decreased general fatigue, physical fatigue and less reduced activity. Higher CSM circadian preference scores are associated with decreased general and physical fatigue, and less reduced activity. Increased seasonality is associated with more physical fatigue. Lower sleep quality is associated with greater general and physical fatigue. To our best knowledge this is the first study evaluating associations between chronotype and sleep disturbances with IBD symptoms. We have found that chronotype preferences, whose role in IBD has been until now overlooked, may be one of the important factors contributing to fatigue in this clinical group.

Alterations in serum levels of selected markers of oxidative imbalance in adult celiac patients with extraintestinal manifestations: a pilot study

INTRODUCTION    Oxidative stress is considered to be one of the mechanisms responsible for gluten toxicity, but its role in celiac disease (CD) remains unclear. OBJECTIVES    The aim of the study was to evaluate oxidative imbalance in the pathomechanism of CD by determining the concentrations of nitric oxide (NO) and selected antioxidant parameters. PATIENTS AND METHODS    The study involved 197 adult patients: 53 patients with untreated active CD, 92 celiac patients on gluten‑free diet (GFD), and 52 controls. The serum levels of antioxidants (uric acid, bilirubin, ferritin, albumin), celiac antibodies, NO, glutathione peroxidase 3 (GPx3), and vitamin E were measured. A histopathological study of duodenal biopsy was performed. RESULTS    Celiac patients had higher uric acid concentrations than controls (P <0.001). NO levels were higher in patients with active CD than in controls (P <0.01) and were correlated with the degree of mucosal damage (r2 = 0.04; P = 0.01). Vitamin E levels were decreased in celiac patients (P <0.01), and GPx3 activity was reduced in patients with active CD compared with controls (P <0.001). CONCLUSIONS    Oxidative imbalance may be involved in the pathomechanism of CD in adults. GFD only partially reduces oxidative stress. Serum NO levels seem to be a marker of the effectiveness of treatment. Uric acid may act as an antioxidant in CD.

Ferric reducing ability of plasma and assessment of selected plasma antioxidants in adults with celiac disease

INTRODUCTION

Oxidative stress with an excessive free radical production and a reduction in the activity of protective antioxidants is considered as one of the mechanisms responsible for gluten toxicity. However, its role in celiac disease (CD) is unclear.

OBJECTIVES

Evaluation of plasma nonenzymatic antioxidant capacity in patients with CD (both untreated patients and those receiving gluten-free diet [GFD]) by measuring the ferric reducing ability of plasma (FRAP) as well as assessing selected plasma antioxidants.

PATIENTS AND METHODS

The study included 169 adult patients: 48 patients with untreated active CD, 72 patients with CD on a GFD, and 49 healthy controls. In each group, we measured the serum levels of selected antioxidants (uric acid, bilirubin, albumin, and vitamin E) and used the FRAP assay to assess the total antioxidant capacity (TAC) of plasma. In each patient, serological and histopathological activity of CD was also evaluated.

RESULTS

There were no significant differences in the TAC of plasma measured with the FRAP assay between the study groups. Patients with CD had higher uric acid levels compared with controls (p <0.001), while bilirubin levels were lower in patients with active disease than in controls (p <0.05). Serum vitamin E levels were lower in all patients with CD compared with controls (p <0.01).

CONCLUSIONS

The FRAP assay is not the method of choice for assessing the TAC of plasma in patients with CD. Owing to high serum uric acid levels, the FRAP assay results in these patients may be overestimated despite the reduced levels of other plasma antioxidants.

Concentrations of antiganglioside M1 antibodies, neuron-specific enolase, and interleukin 10 as potential markers of autonomic nervous system impairment in celiac disease

INTRODUCTION Celiac disease (CD) is an immune-mediated enteropathy related to permanent gluten intolerance, characterized by gastrointestinal symptoms as well as nongastrointestinal symptoms, including neurologic ones. The presence of neuron-specific enolase (NSE), interleukin 10 (IL-10), and antiganglioside M1 (anti-GM1) antibodies has been demonstrated for neurologic conditions as well as immune disorders with neurologic manifestations. OBJECTIVES The aim of the study was to determine the concentrations of IL-10, NSE, and anti-GM1 antibodies in the course of CD and their correlation with changes in electrogastrography (EGG) and with heart rate variability (HRV). PATIENTS AND METHODS The study included 68 participants: 34 patients with CD and 34 healthy individuals. We assessed the concentrations of IL-10 and NSE as well as the presence of anti-GM1 antibodies in serum. We investigated correlations between the concentrations of IL-10, NSE, and anti-GM1 antibodies and the results of EGG and HRV. RESULTS Patients with CD had a higher level of anti-GM1 antibodies than controls (1.38 ng/ml [0.98-2.03 ng/ml] vs 0.81 ng/ml [0.35-1.15 ng/ml]). Median IL-10 concentrations in patients with CD differed significantly from those in controls (7 pg/ml [4.33-11.48 pg/ml] vs 4.27 pg/ml [2.44-7 pg/ml]; P = 0.010). In HRV analysis, a positive correlation between IL-10 concentrations and very low frequency spectrum was observed (r = 0.63; P = 0.003). There was no correlation between the concentrations of IL-10, NSE, or anti-GM1 antibodies and EGG parameters. CONCLUSIONS Chronic inflammation in the course of CD may lead to autonomic nervous system impairment and development of neurologic disorders. Therefore, anti-GM1 antibodies and IL-10 may be considered as markers of nervous system impairment in the course of CD.

Ghrelin, pancreatic polypeptide plasma concentrations and gastric myoelectric activity in celiac disease

BACKGROUND/AIMS

The aim of the study was to analyze the effect of celiac disease(CED) on the upper-gut motility and release of enteral hormones (ghrelin and pancreatic peptide (PP)).

MATERIALS AND METHODS

the study included 25 patients diagnosed with CED and 30 healthy controls. Gastric myoelectric activities (EGG) in a fasted and fed state were recorded. The plasma concentrations of ghrelin and PP were determined. R e s u l t s: CED patients presented in a fasted state a decreased percentage of normogastria 54.8 ± 24.5 vs. 86 ± 12.3%, p = 0.02 and slow wave coupling (SWC) 52.7 ± 13.4 vs. 77.4 ± 11.9%; p = 0.00001 with increased dominant power (DP) 11.6 ± 1.5 vs. 11.1 ± 1.1. Contrary to the controls, they did not show an improvement in the percentage of normogastria, DP and SWC when examined in a fed state (p 〈0.05). Furthermore, CED patients presented with significantly lower fasting plasma concentrations of ghrelin 156.8 ± 86.7 vs. 260.2 ± 87.6 pg/ml, p = 0.0002 and significantly higher fasting PP levels than did the controls 265.2 ± 306.3 vs. 54.1 ± 54.6 pg/ml, p = 0.0005. C o n c l u s i o n: CED affects gastric myoelectric activity (decreasing normogastria and coupling) and causes changes in fasting concentrations of enteral hormones (decrease in ghrelin and an increase in PP). Gastric myoelectric response to food is abolished in CED patients, probably due to the neurohormonal changes induced by primary inflammation associated with this disease.

Clinical course of primary sclerosing cholangitis and concomitant ulcerative colitis - a preliminary report of retrospective study among patients from Southern Poland

Both ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) are chronic and progressive diseases of uncertain etiology, that may affect one patient. Approximately 70% of PSC cases are also diagnosed with UC, whereas in the group of UC the prevalence of PSC is about 2-5%. The aim of the study was to compare clinical courses of PSC and UC in patients diagnosed with both diseases to those with the confirmed diagnosis of either PSC or UC. Three groups were distinguished and evaluated: patients with PSC and UC (n = 17) and two control groups: patients with PSC (n = 4) and with UC (n = 13). Clinical data, symptoms, laboratory tests, results of the magnetic resonance cholangiopancreatography and colonoscopy were analyzed to compare clinical courses of these diseases between the groups.

CONCLUSION

there is no correlation between clinical course of simultaneous PSC and UC. However, it may differ depending on co-occurrence of the other disease.

Levofloxacin resistance of Helicobacter pylori strains isolated from patients in southern Poland, between 2006-2012

An increasing resistance of Helicobacter pylori (H. pylori) to antimicrobial agents leads to the need of regional monitoring of the prevalence resistant strains (according to the Maastricht/Florence consensus report, 2012). The aim of the study was to assess the resistance to levofloxacin of H. pylori strains isolated from adult patients of Małopolska region in Poland. Bioptates taken from gastric mucosa during gastroscopy constituted the material for the study. Two hundred ten H. pylori strains were isolated from 811 patients. A majority of strains (171) came from patients before the treatment of H. pylori infections while the remaining 39 strains were isolated from patients after the failed therapy. Susceptibility of H. pylori to levofloxacin was determined by strips impregnated with antibiotic gradient (E-test, bioMerieux). The obtained minimum inhibitory concentration (MIC) values ranged from 0.002 mg/L to 32 mg/L. The percentage of strains resistant to levofloxacin amounted to 8.10% (17/210). Among the group of strains isolated from patients before the treatment, 5.85% (10/171) of H. pylori strains were resistant to levofloxacin. In the group of strains isolated from patients after the treatment 17.95% (7/39) of strains were resistant. The difference in the frequency of H. pylori strains resistant to levofloxacin in patients before and after the treatment of the infection due to H. pylori was statistically significant (p = 0.0297). The low percentage of H. pylori strains resistant to levofloxacin justify that the introduction of a triple therapy with levofloxacin is a good alternative in the treatment of H. pylori infections, especially in regions with high prevalence of H. pylori strains resistant to clarithromycin (> 20%).

[Endoscopic and histopathological findings of the upper gastrointestinal tract in patients with functional and organic dyspepsia]

INTRODUCTION

Endoscopic examination of the upper gastrointestinal tract (upper GI) with macroscopic and histopathological evaluation provides essential tool to differentiate the organic and functional causes of dyspepsia. The distinction, however, is often smooth and not fully defined. The aim of this study was to assess the frequency and type of the macroscopic and histopathological changes in the upper GI endoscopy in patients with symptoms of dyspepsia.

MATERIAL AND METHODS

A retrospective study was performed on 212 patients with dyspepsia, at the age of 18-84 years, including 60 patients to 45 years of age (group I) and 152 patients older than 45 (group II) who underwent gastroscopy. The severity of esophagitis was classified according to the Los Angeles Classification and gastritis according the updated Sydney system. Biopsy specimens were taken from the gastric and duodenum for histopathological examination. The presence of H. pylori infection has been established on the basis of histopathological examination and positive rapid urease test.

RESULTS

Reflux esophagitis was found in 18 patients (8.5%), slightly more common in people over 45 years of age (group I--5%, group II--9.2%). The mild forms of esophagitis occurred most frequently. A more advanced form of inflammation and Barrett's esophagus was found only in patients over 45 years of age. Normal gastric and duodenal mucosa was revealed in 30% of patients in group I and 9.2% in group II. The most common endoscopic lesion was gastritis, mostly erythematous-exudative and less often atrophic. The presence of H. pylori infection was varied in the different types of inflammation. H. pylori infection occurred most frequently in the case of erosive and follicular gastropathy. The most common location of H. pylori infec- frequent in older patients. Peptic ulcer was found in 4.7% of patients (group I--5%, group II--4.6%). In one patient (61 years old) stomach cancer was diagnosed and in one patient (<45 years old) Crohn's disease of the upper GI was diagnosed. The majority of patients had normal duodenal mucosa. In 3.3% of patients (group I--8.3%, group II--1.3%), who had not previously diagnosed celiac disease, histopathological changes typical of celiac disease has been shown. In all patients, in whom biopsy specimens were taken from normal duodenal mucosa (14% of patients), histopathological examination revealed the presence of non-specific inflammation, regardless of the coexistence of H. pylori infection.

CONCLUSION

Regardless of the severity of lesions of the upper GI endoscopy in patients with dyspepsia, it is advisable to take biopsy from the gastric and duodenal mucosa, which allows for an individualized management of these patients. Celiac disease should be considered in the diagnosis of the causes of dyspepsia. Further studies of microscopic duodenitis in patients with dyspepsia are needed.

[Hereditary hemochromatosis and mild unconjugated hyperbilirubinemia in patient with ulcerative colitis]

We present the case of 51 year old man with 10 year history of ulcerative colitis. Results of laboratory test revealed increased serum levels of iron, ferritin as well as moderate hiperbilirubinemia. Transferrin saturation index was high, 98,7% (N< 50%). Long lasting remission of inflammatory bowel disease, including lack of bleeding from gastrointestinal tract disclosed hereditary hemochromatosis presence in that patient.

Primary and secondary clarithromycin, metronidazole, amoxicillin and levofloxacin resistance to Helicobacter pylori in southern Poland

The aim of this study was to assess the primary and secondary resistance of H. pylori strains cultured from adult patients of the Małopolska region of Poland, mainly of Kraków and the surrounding areas, to antibacterial agents (amoxicillin, clarithromycin, metronidazole and levofloxacin). In total, 115 H. pylori strains were isolated, of which 90 strains originated from patients who had never been treated for H. pylori infection, while the remaining 25 were isolated from patients in whom eradication of the infection failed after treatment. All tested H. pylori strains were susceptible to amoxicillin. Forty-four percent of strains isolated were resistant to metronidazole. The primary and secondary resistance to this antimicrobial chemotherapeutic reached 37% and 72% (p = 0.002), respectively. In total, 34% of strains were resistant to clarithromycin, and the ratio of strains with secondary resistance was significantly greater than that of the strains with primary resistance (80% vs. 21%, p < 0.001). The double resistance to both metronidazole and clarithromycin was confirmed in 23% of H. pylori strains. Five percent of H. pylori strains were resistant to levofloxacin, while primary and secondary resistance to this drug accounted for 2% and 16% (p = 0.006), respectively. In total, 4% of H. pylori strains were simultaneously resistant to metronidazole, clarithromycin and levofloxacin. Thus, the high resistance to metronidazole and clarithromycin excludes the possibility of using these drugs for treatment of H. pylori infection without earlier antibiogramming. Levofloxacin, as a drug of high efficacy against H. pylori, should be reserved for an "emergency" therapy and used in a limited capacity in order to preserve its potent antimicrobial activity. The Polish Society of Gastroenterology recommends levofloxacin as a third-line therapy.

[Effectiveness of anti-TNF alpha antibodies in treatment of fistulizing Crohn's disease]

INTRODUCTION

About 35% of patients with Crohn's disease develop fistulae. Treatment of those changes is a complicated clinical problem. Anti-TNF alpha antibodies are currently the most effective therapy of fistulizing Crohn's disease. Aim of the study is to evaluate results of anti-TNF alpha treatment in patients with fistulizing Crohn's disease.

METHODS

We evaluated results of anti-TNF alpha treatment (both with adalimumab n=10 and infliximab n=19) in 29 patients with fistulizing Crohn's disease treated in years 2008 - 2011 in Gastroenterology and Hepatology Clinic of University Hospital in Krakow.

RESULTS

Closure of over 50% of fistulas was achieved by 78,94% patients after induction therapy with infliximab and 50% with adalimumab. Long term remission, evaluated after 52 weeks of treatment, was observed in 46,15% patients treated with infliximab. Best results were observed in perianal fistulas treatment - remission was achieved in 88.2% of patients. Effectiveness of enterocutaneus fistalas therapy was lower, and their healing was observed in 28.57% of patients. We observed no correlation between duration of Crohn's disease, duration of fistulas history or previously used treatment and results of anti-TNF alpha treatment.

CONCLUSIONS

Anti-TNF alpha treatment has high effectiveness both short and long term in fistulizing Crohn's disease. Tolerance of treatment is very good. We lack clinical data about treatment other fistulas than perianal, but we suspect that effectiveness of anti-TNF alpha in this cases is lower. It is indicated to treat patients with fistulizing Crohn's disease with anti-TNF alpha, because it gives them chance for long remission and improvement of quality of life.

[Clinical symptoms variety in adults with celiac disease]

Celiac disease, called gluten enteropathy, is a chronic disorder, characterized by the immunologic answer to the gluten contained in the wheat, barley and oat in genetically predisposed patients. The frequency of celiac disease is estimated on 0.5-1% in the adult population and proportion of diagnosed to non-diagnosed cases is 1 to 7. The clinical picture of that disease in adults presents wide spectrum of gastrointestinal and extraintestinal symptoms. There is 5-10 fold increased risk of its coexistence with other autoimmune diseases, such as diabetes mellitus type I, juvenile arthritis or autoimmune thyroiditis. Abnormal liver function or vascular thrombosis are also observed. Acute abdominal pain as the leading symptom is present in 16.3% of celiac cases. Moreover the increased frequency of the microscopic colitis and gastritis may influence on the persistence of clinical symptoms.

[Coeliac disease and other autoimmunological disorders coexistance]

Coeliac disease (gluten enteropathy) is a chronic inflammatory disease of the gastrointestinal (GI) tract of autoimmune etiology in genetically predisposed individuals. It is the most frequent enteropathy with frequency of 1/100 and 1/300 in the adult population in America and Europe respectively. Typical form of celiac disease including abdominal pain, weight loss, nausea is quite rare in adults. In some coeliac patients, symptoms persist in spite of strict gluten free diet. One of the reasons of this is interference of the autoimmune diseases. Results of our studies revealed in the group of 110 patients with diagnosed gluten enteropathy, coexistence of autoimmune disease, such as diabetes mellitus type 1 in 7.2% cases, hyperthyreosis on 1.8% of cases, vitiligo in 0.9% of cases, primary biliary cirrhosis in 2% of cases and rheumatoidal arthritis in 0,9 of cases. In the group of 80 ulcerative colitis patients, coexistence of celiac disease basing on serological histopatological investigation was found in 4 patients (5%).

CONCLUSIONS

Coexistence of coeliac disease with other autoimmune diseases is quite frequent. Gluten enteropathy symptoms may be interpreted as originating from other autoimmune disease. It can delay the diagnosis of celiac disease and introduction of gluten free diet, which improves the quality of life and protects from dangerous GI complications.

[Frequency of celiac disease and irritable bowel syndrome coexistance and its influence on the disease course]

Celiac disease is increasingly recognized autoimmune enteropathy caused by a permanent gluten intolerance. Gluten is the main storage protein of wheat, in genetically predisposed individuals. Celiac disease risk in first degree relatives is about 10%. Diarrhea and changes of bowel movement, observed as well in celiac disease as in IBS, may lead to misdiagnosis of IBS basing on the Rome criteria or may be associated with coexistence of both diseases. The aim of the study was to assess the celiac disease prevalence in patients with irritable bowel syndrome. The study group comprised 200 patients (120 women and 80 men) aged 18-78 years (mean: 46.7 years) with diarrhoeal form of irritable bowel syndrome (IBS), according to the Rome criteria II. At the beginning and after a three month period anti tissue transglutaminase antibodies (IgA tTG) were estimated. Gastroscopy with biopsy where performed in those with IgA tTG titre above 1/200. 40 patients were immunologically positive and 14 of them have histopathologically proven celiac disease. In the group of patients with detected celiac disease, gluten free diet was applied besides the treatment with trimebutin or mebewerin, recommended for IBS. After 6 months the decrease of IgA tTG titre in the serum was observed. In 5 of these patients IgA tTG level was negative. It was associated with the significant decrease of clinical symptoms, such as diarrhea and flatulence. The remaining symptoms, such as abdominal pain, feeling of incomplete defecation demanded continuation of IBS treatment. With regard to often atypical celiac disease symptoms--adult active searching should be performed to differentiate from irritable bowel syndrome.

[The role of celiac disease and type 1 diabetes coexistance. Is celiac disease responsible for diabetic status?]

Celiac disease is the status of the autoimmune answer provoked by gluten ingestion in genetically predisposed people. Recently gluten entheropathy was considered as a rare clinical problem in adults. Celiac disease is an autoimmune disorder that can coexist with other diseases, such as diabetes mellitus type 1 (DMID), thyroid gland diseases. The aim of our study was evaluation of the frequency of coexistence of celiac disease with DMID using the level of anti tissue transglutaminase antibodies (IgA- tTG) and mucosal biopsy from the distal part of the duodenum. An attempt was made to estimate the influence of celiac disease on the intensity of clinical symptoms and metabolic balance in patients with DMID. Our study included 109 patients with DMID, aged 18-52 years. The frequency of the incidence of celiac disease in DMID patients was 9.71%. Gastric symptoms, such as diarrhea, abdominal pain were more frequent in patients with villous atrophy in the intestine. Hyperglycemia and problems with glucose balance in the serum were observed. Introduction of the gluten free diet led to improvement quality of life, less frequent hypoglycemic episodes and disappearance of diarrhea, increase of serum iron and decrease of IgA-tTG level in the serum. It is necessary to measure the level of IgA- tTG in patients with DMID. Diagnosis of celiac disease in patients with DMID and its treatment with gluten free diet causes the clinical, histological and biochemical improvement in these patients.

[Usefulness of non-steroid antiinflammatory drugs in patients with ulcerative colitis]

Non specific inflammations of the intestine are the group of chronic disorders, such as ulcerative colitis and Crohn's disease and with episodic aggravation of inflammatory lesions, called active phase and non-active phase, called remission. Non-steroid antiinflammatory drugs (NSAIDS) are one of the most frequently used medications in the World. NSAIDS therapy in ulcerative colitis patients is a very important clinical problem, because of frequent extraintestinal symptoms, such as arthritis, which make patients to take these drugs. But the mechanisms of the NSAIDS influence on the course of inflammatory diseases of inferior part of gastrointestinal tract is still not known. Our results of clinical studies indicated the influence of nonselective and selective COX2 inhibitors on ulcerative colitis activity. However clinical aggravation was detected in 8% of patients treated with conventional NSAIDS and in one person administered selective COX2 inhibitor. Administration of the conventional NSAIDS as well as coxibs, significantly influenced severity of diarrhea. Moreover conventional COX inhibitors increased severity of colon bleeding and endoscopic colon inflammatory lesions in comparison to ulcerative colitis patients, as well not administered NSAIDS as given coxibs. Total patients evaluation involving the intensity of clinical symptoms did not reveal significant differences between examined groups. The above results showed, that the balance between risk and advantages resulting from administration of NSAIDS both, non-selective and selective COX is to be accepted in ulcerative colitis patients in non-active phase.

[Celiac disease and other immunomediated diseases coexistance and influence of clinical course. Case report]

Celiac disease (gluten enteropathy) is chronic immunomediated disorder of gastrointestinal tract in genetically predisposed patients. We present the case of 46 years old man, with already diagnosed several autoimmune disorders, such as: diabetes mellitus LADA type, Graves-Basedow disease and vitiligo. Despite treatment of the above diseases, diarrhea and persistent abdominal pain was observed. Diagnosis of gluten enteropathy based on serology and histological evaluation of biopsies from distal part of duodenum enabled us to introduce gluten free diet, which contributed to attenuation of symptoms and better control of glucose serum levels. We think, that celiac disease should be taken into the consideration in differential diagnosis of chronic diarrhea and persistent abdominal pain, especially in patients with coexisting autoimmune diseases.

[Evaluation of chromogenic media in microbiological diagnostics]

The aim of the study was the evaluation ofchromogenic agars as a screening media in the routine microbiological diagnostics. 627 clinical samples were cultured on the chromogenic media: chromID S. aureus, chromID MRSA, chromID CPS3 and chromID ESBL from bioMerieux. The results of presumptive identification and detection of selected resistance mechanisms by chromogenic media were compared with results obtained with the conventional methods. Our studies revealed the highest sensitivities of chromID MRSA and chromID CPS3 (> 90%). The sensivities for chromID ESBL and chromID S. aureus were > 70%. All media were also highly specific (97%). This specificity for chromID S.aureus and chromID CPS3 was 100%. We conclude, that all tested media showed good performance in presumptive identification and detection of resistance mechanisms.

[Epidemiology, classification and management of functional dyspepsia]

Functional dyspepsia belongs to functional disorders of the gastrointestinal tract. Its prevalence is estimated up to 25% of adult population of Western countries. On the contrary to irritable bowel syndrome, functional dyspepsia is slightly more frequent in men. The recent classification of functional dyspepsia includes its two subcategories: postprandial distress syndrome (DS, B1a) and epigastric pain syndrome (EPS, B1b). In the management of functional dyspepsia three strategies are taken into the consideration: 1. early gastroscopy performed in people over 45 years of age and independent of age in case of alarm symptoms. 2. Therapy based on noninvasive H. pylori testing: in young adults with dyspeptic symptoms, without alarm symptoms and not treated with nonsteroid antiphlogistic medications. 3. Empiric treatment: considered as an initial therapy in patients not diagnosed with dyspepsia, without alarm symptoms and in dyspeptic patients despite H. pylori eradication. In the treatment of functional dyspepsia the following treatments are applied: dietary treatment, farmacotherapy with antisecretory drugs, prokinetics, H. pylori eradication, antidepressants and psychotherapy. Directions of the further investigation in functional dyspepsia include: improvement of endoscopic methods, and searching for new groups of medications according to the new Rome III classification of functional dyspepsia, based on its pathophysiology.

[Studies on the influence of Candida fungal colonization on the healing process of inflammatory lesions in the colon in rat animal model]

Present-day methods of successful treatment of inflammatory bowel diseases (IBD) result from a better understanding of their pathophysiology due to advances in preclinical studies in this area of knowledge. Until recently microbiological studies have been focused on the bacterial aspects in pathogenesis of GI disorders, however in the last years an interest in the presence of fungi in the gastrointestinal tract has also increased. In this study using an animal model of ulcerative colitis, the impact of fungal colonization of the colon on the intensity of inflammatory changes in the colonic mucosa and the course of their healing was carried out. The macroscopic and microscopic criteria relating to the changes of weight of examined fragments of the colon were evaluated while assessing differences between groups tested. The intensity of intestinal inflammatory changes was determined by assessment of such parameters, as colonic blood flow (CBF), the level of MPO as a marker of colonic neutrophil infiltration intensity and the plasma levels of IL-1beta; and TNF-alpha concentrations. Results at the 3rd day after TNBS rectal administration revealed an increase of weight of isolated segments of inflammed colon, a decrease of CBF and the 4-5 fold increase of plasma MPO activity. Candida colonization of colon mucosa of rats delayed healing of colonic ulcers, induced by TNBS and this was associated with the increased expression of plasma IL-1beta and TNF-alpha levels. Administration of antifungal (fluconazole) or probiotic (Lacidofil) treatment to C. albicans infected rats exerted favorable effect on healing of inflammatory changes in the colon because the area of ulcerations in groups of rats treated with fluconazole or Lacidofil was significantly smaller in comparison with those inoculated with Candida solution only. Administration of fluconazole or Lacidofil significantly decreased the weight of colon segments, the MPO activity and the plasma IL-1beta and TNF-alpha levels, as compared with respective values in the group receiving Candida only. The results of our studies indicate the deteriorating influence of Candida on the healing process of inflamed colon in the animal model of ulcerative colitis. Concomitant therapy with probiotic or antifungal treatment improved healing of colonic lesions, decreased the weight of inflamed colonic tissue and also attenuated the MPO activity and plasma proinflammatory cytokines IL-1beta and TNF-alpha levels.

[Candidiasis in the experimental model of ulcerative colitis]

In the present study on animal model of ulcerative colitis the influence of fungal colonization on the severity of inflammatory lesions in the colon and the course of their healing was evaluated. The results of our studies revealed, that significant fungal colonization (over 10(4) CFU/ml) delayed ulcer healing in the colon. It corresponded with the decrease of colonic blood flow (CBF) in the region of lesions and increase of interleukin (IL)-1beta, tumor necrosis factor(TNF)-alpha level in the serum. Introduction of antifungal therapy (fluconazole) or probiotic in rats inoculated with Candida accelerated the process of ulcer healing in the colon, expressed through the reduction of macro- and microscopic lesions in the colon and decrease of MPO, IL-beta TNF-alpha serum level.

Are probiotics effective in the treatment of fungal colonization of the gastrointestinal tract? Experimental and clinical studies

The influence of fungal colonization and probiotic treatment on the course of gastric ulcer (GU) and ulcerative colitis (UC) was not explored. Our studies included: 1) clinical investigation of 293 patients with dyspeptic and ulcer complaints and 72 patients with lower gastrointestinal (GI) tract: 60 patients with UC, 12 with irritable bowel syndrome (IBS) - the control group. Significant fungal colonization (SFC), over 10(5) CFU/ml was evaluated. Mycological investigation was performed, including qualitative and quantitative examination, according to Muller method, 2) experimental studies in rats included estimation of the influence of inoculation of Candida isolated from human GI tract on the healing process of GU, induced by acetic acid with or without probiotic Lactobacillus acidophilus (10(6) CFU/ml) introduced intragastrically (i.g.). At 0, 4, 15 and 25 day after ulcer induction. Weight, damage area, gastric blood flow (GBF) (H2 clearance), expression of mRNA for cytokines IL-beta, TNF-alpha (ELISA) were evaluated. Mycology: qualitative and quantitative examination was performed. MPO serum activity was measured. Results of clinical studies: 1) SFC was more frequent in patients with GU: 54.2% of cases and patients with over 5 years history of UC: 33.3% cases. 2) SFC delayed GU healing and influenced the maintenance of clinical symptoms in both diseases. Results of animal studies: 3) In Candida inoculated rats, the GBF was significantly lower than in the vehicle controls (saline administered group). Upregulation of TNF-alpha, IL-1 beta was recorded. The GUs were still present till 25 day in all rats inoculated with Candida, in contrast to vehicle group (reduction of ulcer in 92% at day 25).

CONCLUSIONS

1) Fungal colonization delays process of ulcer and inflammation healing of GI tract mucosa. That effect was attenuated by probiotic therapy. 2) Probiotic therapy seems to be effective in treatment of fungal colonization of GI tract. 3) Lactobacillus acidophilus therapy shortens the duration of fungal colonization of mucosa (enhanced Candida clearance is associated with IL-4, INF-gamma response).

[The influence of Candida albicans on the course of ulcerative colitis]

The influence of microbiological factor is taken into consideration in the pathogenesis of ulcerative colitis (UC). The aim of studies was to: 1.evaluate the presence of significant fungal colonization, over 10(5) CFU/ml in patients with UC and the control group (irritable colon syndrome, IBS); 2. estimate the influence of antifungal treatment in the activity of UC.

MATERIAL AND METHODS

We evaluated 72 patients aged from 18-72 years, 60 patients with UC, 12 with IBS. Clinical investigation: initially and after 4 weeks interview and colonoscopy with colon biopsies for histology and mycology were taken. Activity of UC was evaluated according to: clinical, endoscopic and histological IACH criteria. 13 patients with significant fungal colonization were given antifungal treatment. Biopsies for histology were stained with hematoxylin-epsin (H-E). Qualitative and quantitative mycolo-gical evaluation was performed according to Muller method.

RESULTS

1. Significant fungal colonization was more frequent in patients with UC history over 5 years, in comparison with shorter disease history and IBS, in 33.3%, 13.8% and 1.3% respectively. 2. Candida albicans was most often isolated in 91.7% of cases. 3. Initial analysis of the activity index of UC in patients with significant and non-significant fungal colonization did not revealed differences between these groups, 13.84 and 14.0 respectively. 3. After 4 weeks stronger decrease of the UC activity index was observed in patients with significant fungal colonization treated with antifungal treatment, in comparison with patients not given antifungal therapy: 8.0 and 10.41 respectively, p<0.01. Differences were significant according to clinical 2.23 (C) -3.33 (D), p<0.05 and endoscopic cryteria: 3.46 (C) -4.84 (D), p<0.01.

CONCLUSIONS

1. Significant fungal colonization of colon may influence the activation of UC. 2. Longer disease history may be the risk factor of significant fungal colonization in colon. 3. Antifungal treatment in patients with significant colonization caused clinical improvement of UC.

Effect of fungal colonization of gastric mucosa on the course of gastric ulcers healing

BACKGROUND

The aim of the study was to evaluate the effect of fungal colonization on the course of gastric ulcer disease with particular regard to regression of clinical symptoms and reduction in ulcer niche size.

MATERIAL AND METHODS

The study was performed on the group of 293 patients, aged 20-80, with clinical symptoms of peptic ulcer disease, who attended Gastroenterology Outpatient Department of Collegium Medicum of Kraków Jagiellonian University. Endoscopy of the upper gastrointestinal tract was performed before and following a-4-week period of a standard anti-ulcerous treatment. During the examination aspirate of the stomach contents and surface brushing were collected. Moreover, biopsy specimens from the bottom of the ulcer or inflamed gastric mucosa were taken for mycological and histopathological examinations. According to contemporary recommendations eradication treatment of Helicobacter pylori was introduced in urease-positive patients with endoscopy-proved gastric ulcer.

RESULTS AND CONCLUSIONS

The results of our research showed that fungal colonization of gastric ulcers impairs the course of ulcer healing. Moreover, it results in clinical symptoms maintenance as compared with ulcers with non-significant fungal cells count.

Fungal colonization of the stomach and its clinical relevance

The aim of this study was to estimate the frequency of fungal colonization of the stomach of patients suffering from gastric ulcer (GU) and chronic gastritis (CG) and the influence of fungal colonization of the stomach on the process of ulcer healing. We investigated 293 patients aged 20-80 years. Before and after 4 weeks of sucralfate treatment they underwent endoscopy of the stomach, histological examination of biopsies taken from the ulcer margin or inflamed gastric mucosa and mycological examinations of the gastric juice, surface brushing and biopsies. The studies revealed a high concentration of fungi in 54.2% patients with GU and 10.3% with CG. Candida albicans was the most frequently isolated organism. Fungal colonization of the stomach impairs the process of gastric ulcer healing. Control examination after 4 weeks of sucralfate therapy showed the ratio of GU healing in 62% of patients with a high concentration of fungi in comparison with 78% of patients not colonized with fungi (P < 0.05). A significantly longer duration of ulcer symptoms in the group of patients with a high concentration of fungi in the stomach was also observed. There was no correlation between the level of fungal antibodies, of Candida antigen in the serum and the concentration of fungi in the stomach.