1
|
Fábián A, Bor R, Vasas B, Szűcs M, Tóth T, Bősze Z, Szántó KJ, Bacsur P, Bálint A, Farkas B, Farkas K, Milassin Á, Rutka M, Resál T, Molnár T, Szepes Z. Long-term outcomes after endoscopic removal of malignant colorectal polyps: Results from a 10-year cohort. World J Gastrointest Endosc 2024; 16:193-205. [PMID: 38680198 PMCID: PMC11045354 DOI: 10.4253/wjge.v16.i4.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/28/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging, and evidence regarding a surveillance-only strategy is limited. AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps. METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020. Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were investigated. Event rates for categorical variables and means for continuous variables with 95% confidence intervals were calculated, and Fisher's exact test and Mann-Whitney test were performed. Potential risk factors of adverse outcomes were determined with univariate and multivariate logistic regression models. RESULTS In total, 135 lesions (mean size: 22.1 mm; location: 42% rectal) from 129 patients (mean age: 67.7 years; 56% male) were enrolled. The proportion of pedunculated and non-pedunculated lesions was similar, with en bloc resection in 82% and 47% of lesions, respectively. Tumor differentiation, distance from resection margins, depth of submucosal invasion, lymphovascular invasion, and budding were reported at 89.6%, 45.2%, 58.5%, 31.9%, and 25.2%, respectively. Residual tumor was found in 10 patients, and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection. Univariate analysis identified piecemeal resection as a risk factor for residual malignancy (odds ratio: 1.74; P = 0.042). At least 1 year of follow-up was available for 117 lesions from 111 patients (mean follow-up period: 5.59 years). Overall, 54%, 30%, 30%, 11%, and 16% of patients presented at the 1-year, 3-year, 5-year, 7-year, and 9-10-year surveillance examinations. Adverse outcomes occurred in 9.0% (local recurrence and dissemination in 4 patients and 9 patients, respectively), with no difference between patients undergoing secondary surgery and surveillance only. CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement. Long-term adverse outcome rates might be higher than previously reported, irrespective of whether secondary surgery was performed.
Collapse
Affiliation(s)
- Anna Fábián
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Renáta Bor
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Medical Informatics, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6720, Hungary
| | - Tibor Tóth
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Zsófia Bősze
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Kata Judit Szántó
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Péter Bacsur
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Anita Bálint
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Bernadett Farkas
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Klaudia Farkas
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
- USZ Translational Colorectal Research Group, Hungarian Centre of Excellence for Molecular Medicine, Szeged 6725, Hungary
| | - Ágnes Milassin
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Mariann Rutka
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Tamás Resál
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Tamás Molnár
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Zoltán Szepes
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| |
Collapse
|
2
|
Bacsur P, Wetwittayakhlang P, Resál T, Földi E, Vasas B, Farkas B, Rutka M, Bessissow T, Afif W, Bálint A, Fábián A, Bor R, Szepes Z, Farkas K, Lakatos PL, Molnár T. Accuracy of the Pancolonic Modified Mayo Score in predicting the long-term outcomes of ulcerative colitis: a promising scoring system. Therap Adv Gastroenterol 2024; 17:17562848241239606. [PMID: 38524790 PMCID: PMC10958809 DOI: 10.1177/17562848241239606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
Background Different endoscopic scoring systems for assessing ulcerative colitis (UC) severity are available. However, most of them are not correlated with disease extent. Objectives Our study aimed to compare the predictive value of the PanMay score versus the endoscopic Mayo (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and Dublin score in predicting long-term outcomes of UC. Design This retrospective study enrolled consecutive UC patients who underwent colonoscopy before at least a 3-year follow-up. Methods The PanMayo, MES, UCEIS, and Dublin scores and the baseline clinical and demographic characteristics of the participants were assessed. Endpoints were disease flare that required novel biological therapy, colectomy, and hospitalization. Patients were stratified using baseline clinical activity. Results Approximately 62.8% of the 250 enrolled patients were in clinical remission. In these patients, the PanMayo, MES, and Dublin scores were positively associated with the risk of clinical flare. The MES score increased with clinical flare. The PanMayo score (>12 points), but not the MES score, was associated with the need for novel biological initiation and biological escalation. Furthermore, the Dublin and UCEIS scores of patients in remission who need novel biological treatment had a similar trend. Colectomy risk was associated with PanMayo and Dublin scores. Conclusion The combined endoscopic assessment of disease extent and severity can be more accurate in predicting outcomes among patients with UC. PanMayo score can be utilized in addition to the existing scoring systems, thereby leading to a more accurate examination. Summary UC endoscopic scores do not assess extension. Our study aimed to analyze the predictive value of the PanMayo score. Based on 250 patients, results showed that the long-term disease outcomes of UC could be predicted with the PanMayo score more accurately.
Collapse
Affiliation(s)
- Péter Bacsur
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Panu Wetwittayakhlang
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tamás Resál
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Emese Földi
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Béla Vasas
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Bernadett Farkas
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Anita Bálint
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Avenue Cedar, D7-201, Montreal, QC, Canada H3G 1A4
- Department of Oncology and Medicine, Semmelweis University, Üllői st. 26, Budapest H-1085, Hungary
| | - Tamás Molnár
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Kálvária Avenue 57, Szeged H-6725, Hungary
| |
Collapse
|
3
|
Bor R, Vasas B, Fábián A, Szűcs M, Bősze Z, Bálint A, Rutka M, Farkas K, Tóth T, Resál T, Bacsur P, Molnár T, Szepes Z. Risk Factors and Interpretation of Inconclusive Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Solid Pancreatic Lesions. Diagnostics (Basel) 2023; 13:2841. [PMID: 37685379 PMCID: PMC10486755 DOI: 10.3390/diagnostics13172841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The inconclusive cytological findings of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remain a major clinical challenge and often lead to treatment delays. METHODS Patients who had undergone EUS-FNA sampling for solid pancreas lesions between 2014 and 2021 were retrospectively enrolled. The "atypical" and "non-diagnostic" categories of the Papanicolaou Society of Cytopathology System were considered inconclusive and the "negative for malignancy" category of malignancy was suspected clinically. We determined the frequency and predictors of inconclusive cytological finding. RESULTS A total of 473 first EUS-FNA samples were included, of which 108 cases (22.83%) were inconclusive. Significant increases in the odds of inconclusive cytological findings were observed for lesions with a benign final diagnosis (OR 11.20; 95% CI 6.56-19.54, p < 0.001) as well as with the use of 25 G FNA needles (OR 2.12; 95% CI 1.09-4.01, p = 0.023) compared to 22 G needles. Furthermore, the use of a single EUS-FNA technique compared to the combined use of slow-pull and standard suction techniques (OR 1.70; 95% CI 1.06-2.70, p = 0.027) and less than three punctures per procedure led to an elevation in the risk of inconclusive cytology (OR 2.49; 95% CI 1.49-4.14, p < 0.001). Risk reduction in inconclusive cytology findings was observed in lesions between 2-4 cm (OR 0.40; 95% CI 0.23-0.68, p = 0.001) and >4 cm (OR 0.16; 95% CI 0.08-0.31, p < 0.001) compared to lesions ≤2 cm. CONCLUSIONS The more than two punctures per EUS-FNA sampling with larger-diameter needle (19 G or 22 G) using the slow-pull and standard suction techniques in combination may decrease the probability of inconclusive cytological findings.
Collapse
Grants
- K125377 to TM, K134863 to KF, K143549 to TM National Research, Development and Innovation Office
- UNKP-20-5-SZTE-161 to KF, UNKP-22-3-SZTE-233 to PB, UNKP-22-5-SZTE-545 to RB, UNKP-22-4-SZTE-296 to AF, UNKP-22-3-SZTE-278 to TR New National Excellence Program of the Ministry of Human Capacities, Hungary
- BO/00723/22 to RB Janos Bolyai Research Grant, Hungary
- Géza Hetényi Research Grant by Albert Szent-Györgyi Medical School, University of Szeged
Collapse
Affiliation(s)
- Renáta Bor
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Béla Vasas
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary;
| | - Anna Fábián
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary;
| | - Zsófia Bősze
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Anita Bálint
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Mariann Rutka
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Klaudia Farkas
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Tibor Tóth
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Tamás Resál
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Péter Bacsur
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Tamás Molnár
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Zoltán Szepes
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| |
Collapse
|
4
|
Fábián A, Bor R, Bősze Z, Tóth T, Bacsur P, Bálint A, Farkas K, Resál T, Rutka M, Molnár T, Szepes Z. [Endoscopic ultrasound in the lower gastrointestinal tract]. Orv Hetil 2023; 164:1176-1186. [PMID: 37516992 DOI: 10.1556/650.2023.32794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/06/2023] [Indexed: 08/01/2023]
Abstract
Endoscopic ultrasound is a minimally invasive modality that combines endoscopy with ultrasound, providing a possibility to visualize the wall of the gastrointestinal tract and adjacent tissues and organs. Since the development of the modality in the 1980s, advancements in endoscopic ultrasound technology have led to increasingly broadening indications: besides diagnostic indications, therapeutic indications have also expanded greatly. According to recent guidelines regarding rectal cancer staging, rectal ultrasonography is mainly considered to be a secondary imaging modality compared to magnetic resonance imaging. With the use of forward-viewing echoendoscopes and ultrasound miniprobes that can be inserted through the working channel of the endoscope, endoscopic ultrasound technology can be expanded to proximal, colonic areas as well. Rectal ultrasonography can also play an important role in the differential diagnosis of subepithelial lesions, in the detection of rectal varices, in the diagnosis of inflammatory bowel diseases as well as perianal complications. Diagnostic accuracy can further be improved with the addition of ultrasound-guided sampling in certain cases. Currently, therapeutic indications are more like promising possibilities, than part of everyday clinical practice, but this might change in the near future. The purpose of this review is to summarize the current indications of rectal ultrasound in the clinical practice, including diagnostic and therapeutic ones as well. Orv Hetil. 2023; 164(30): 1176-1186.
Collapse
Affiliation(s)
- Anna Fábián
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Renáta Bor
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Zsófia Bősze
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tibor Tóth
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Péter Bacsur
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Anita Bálint
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Klaudia Farkas
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tamás Resál
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Mariann Rutka
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tamás Molnár
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Zoltán Szepes
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| |
Collapse
|
5
|
Resál T, Bacsur P, Horváth M, Szántó K, Rutka M, Bálint A, Fábián A, Bor R, Szepes Z, Fekete J, Farkas K, Miheller P, Molnár T. Nationwide experiences with trough levels, durability, and disease activity among inflammatory bowel disease patients following COVID-19 vaccination. Therap Adv Gastroenterol 2023; 16:17562848231183529. [PMID: 37461738 PMCID: PMC10350576 DOI: 10.1177/17562848231183529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/05/2023] [Indexed: 07/20/2023] Open
Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has complicated the management of inflammatory bowel diseases (IBD). Objectives This study aimed to assess the efficacy of different anti-SARS-CoV-2 vaccines under different treatments in IBD patients and identify predictive factors associated with lower serological response, including anti-tumor necrosis factor (anti-TNF) drug levels. Design A prospective, double-center study of IBD patients was conducted following messenger ribonucleotide acid (mRNA) and non-mRNA anti-SARS-CoV-2 vaccination. Methods Healthy control (HC) patients were enrolled to reduce bias. Baseline and control samples were obtained 14 days after the second dose to assess the impact of conventional and biological treatments. Clinical and biochemical activity, serological response level, and anti-TNF drug levels were measured. Results This study included 199 IBD (mean age, 40.9 ± 12.72 years) and 77 HC participants (mean age, 50.3 ± 12.36 years). Most patients (76.9%) and all HCs received mRNA vaccines. Half of the IBD patients were on biological treatment (anti-TNF 68.7%). Biological and thiopurine combined immunomodulation and biological treatment were associated with lower serological response (p < 0.001), and mRNA vaccination promoted better antibody levels (p < 0.001). Higher adalimumab levels caused lower serological response (p = 0.006). W8 persistence of anti-SARS-CoV-2 level was equal in IBD and HC groups. Vaccination did not aggravate clinical disease activity (p = 0.65). Conclusion Anti-SARS-CoV-2 vaccination is considerably efficacious in IBD patients, with mRNA vaccines promoting better antibody levels. The negative impact of combined biological treatment, especially with high adalimumab drug levels, on serological response to vaccination should be considered. Although midterm durability of vaccination is encouraging, more data are needed to expand the existing understanding on this issue.
Collapse
Affiliation(s)
| | | | | | - Kata Szántó
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - János Fekete
- Department of Bioinformatics, Semmelweis University, Budapest, Hungary
| | | | | | | |
Collapse
|
6
|
Bacsur P, Rutka M, Asbóth A, Resál T, Szántó K, Jójárt B, Bálint A, Ari E, Ajibola W, Kintses B, Fehér T, Pigniczki D, Bor R, Fábián A, Maléth J, Szepes Z, Farkas K, Molnár T. Effects of bowel cleansing on the composition of the gut microbiota in inflammatory bowel disease patients and healthy controls. Therap Adv Gastroenterol 2023; 16:17562848231174298. [PMID: 37324319 PMCID: PMC10265323 DOI: 10.1177/17562848231174298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/20/2023] [Indexed: 06/17/2023] Open
Abstract
Background In patients with inflammatory bowel disease (IBD), Crohn's disease (CD), and ulcerative colitis (UC), numerous cases of exacerbations could be observed after colonoscopy, raising the possible pathogenetic effect of colonic microbiota alterations in IBD flare. Objectives We aimed to investigate the changes in the fecal microbiota composition in IBD patients influenced by the bowel preparation with sodium picosulfate. Design We enrolled patients with IBD undergoing bowel preparation for colonoscopy in the prospective cohort study. The control group (Con) comprised non-IBD patients who underwent colonoscopy. Clinical data, blood, and stool samples were collected before colonoscopy (timepoint A), 3 days later (timepoint B), and 4 weeks later (timepoint C). Methods Disease activity and gut microbiota changes were assessed at each timepoint. Fecal microbiota structure - at family level - was determined by sequencing the V4 region of the 16S rRNA gene. Statistical analysis included differential abundance analysis and Mann-Whitney tests. Results Forty-one patients (9 CD, 13 UC, and 19 Con) were included. After bowel preparation, alpha diversity was lower in the CD group than in the UC (p = 0.01) and Con (p = 0.02) groups at timepoint B. Alpha diversity was significantly higher in the UC group than in the CD and Con (p = 0.03) groups at timepoint C. Beta diversity difference differed between the IBD and Con (p = 0.001) groups. Based on the differential abundance analysis, the Clostridiales family was increased, whereas the Bifidobacteriaceae family was decreased in CD patients compared to the Con at timepoint B. Conclusions Bowel preparation may change the fecal microbial composition in IBD patients, which may have a potential role in disease exacerbation after bowel cleansing.
Collapse
Affiliation(s)
- Péter Bacsur
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - András Asbóth
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
- Department of Genetics, ELTE Eötvös Loránd University, Budapest, Hungary
- Department of Biochemistry and Molecular Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Tamás Resál
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Boldizsár Jójárt
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
- Hungarian Academy of Science – University of Szeged Momentum Epithelial Cell Signaling and Secretion Research Group, Szeged, Hungary
- HCEMM-USZ Molecular Gastroenterology Research Group, Szeged, Hungary
| | - Anita Bálint
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Eszter Ari
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
- Department of Genetics, ELTE Eötvös Loránd University, Budapest, Hungary
- HCEMM-BRC Metabolic Systems Biology Research Group, Szeged, Hungary
| | - Walliyulahi Ajibola
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Bálint Kintses
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
- Department of Biochemistry and Molecular Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- HCEMM-BRC Translational Microbiology Research Group, Szeged, Hungary
- National Laboratory of Biotechnology, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
| | - Tamás Fehér
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
| | - Daniella Pigniczki
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - József Maléth
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
- Hungarian Academy of Science – University of Szeged Momentum Epithelial Cell Signaling and Secretion Research Group, Szeged, Hungary
- HCEMM-USZ Molecular Gastroenterology Research Group, Szeged, Hungary
| | - Zoltán Szepes
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Kálvária Avenue 57, H-6720 Szeged, Hungary
| |
Collapse
|
7
|
Resál T, Matuz M, Keresztes C, Bacsur P, Szántó K, Sánta A, Rutka M, Kolarovszki-Erdei D, Bor R, Fábián A, Szepes Z, Miheller P, Sarlós P, Zacháry A, Farkas K, Molnár T. Conception and reality: Outcome of SARS-CoV-2 infection and vaccination among Hungarian IBD patients on biologic treatments. Vaccine X 2023; 13:100253. [PMID: 36573242 PMCID: PMC9773695 DOI: 10.1016/j.jvacx.2022.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/03/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Inflammatory bowel disease potentially elevates the risk of infections, independently from age, while the disease activity and medical treatment(s) can also increase the risks. Nevertheless, it is necessary to clarify these preconceptions as well during the COVID-19 pandemic. Methods An observational, questionnaire based study was conducted in Hungary between February and August 2021. 2 questionnaires were completed. The first questionnaire surveyed the impact of the pandemic on patients with biologic treatments and assessed the severity and outcome of the infection, whereas the second one assessed vaccination rate and adverse events. Results 472 patients participated in the study. 16.9 % of them acquired the infection and 6.3 % needed hospitalization. None of them required ICU care. Male sex elevated the risk of infection (p = 0.008), while glove (p = 0.02) and mask wearing (p = 0.005) was the most effective prevention strategy. Nevertheless, abstaining from community visits or workplace did not have an impact on the infection rate. Smoking, age, and disease type did not elevate the risk. UC patients had poorer condition during the infection (p = 0.003); furthermore, the disease activity could potentially worsen the course of infection (p = 0.072). The different biological treatments were equally safe; no difference was observed in the infection rate, course of COVID-19. Azathioprine and corticosteroids did not elevate the infection rate. 28 patients (35.0 %) suspended the ongoing biologic treatment, but it had no impact on the disease course. However, it resulted in changing the current treatment (p = 0.004). 9.8 % of the respondents were sceptic about being vaccinated, and 90 % got vaccinated. In one case, a serious flare-up occurred. Discussion Most patients acquired the infection at workplace. Biologic therapies had no effect on the COVID-19 infection, whereas male sex, an active disease, and UC could be larger threat than treatments. Vaccination was proved to be safe, and patient education is important to achieve mass vaccination of the population.
Collapse
Affiliation(s)
- Tamás Resál
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Csilla Keresztes
- Department for Medical Communication and Translation Studies, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Péter Bacsur
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anett Sánta
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Renata Bor
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Pál Miheller
- Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Patrícia Sarlós
- Gastroenterology Unit, 1st Department of Medicine, University of Pécs, Pécs, Hungary
| | - Anita Zacháry
- Hungarian Crohn's and Colitis Association, Budapest, Hungary
| | - Klaudia Farkas
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary,Corresponding author
| |
Collapse
|
8
|
Bor R, Fábián A, Szűcs M, Bálint A, Rutka M, Tóth T, Czakó L, Farkas K, Buzás N, Milassin Á, Molnár T, Szepes Z. Comparison of therapeutic efficacy and treatment costs of self-expandable metal stents and plastic stents for management of malignant biliary obstruction. BMC Gastroenterol 2023; 23:41. [PMID: 36797676 PMCID: PMC9933253 DOI: 10.1186/s12876-023-02668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND According to the European Society of Gastrointestinal Endoscopy guidelines, self-expandable metal stents (SEMSs) are preferable to plastic stents (PSs) in the management of pancreatic cancer, regardless of cancer stage. The aim of this study was to compare the therapeutic efficacy and treatment costs of SEMS and PS in the management of malignant biliary obstruction. METHODS One hundred and thirty-five patients who underwent endoscopic stent placement were retrospectively enrolled and divided into PS (41 patients), primary SEMS (39 patients) and secondary SEMS (55 patients) groups. We determined the technical and functional success rate, stent patency, and cumulative treatment cost. RESULTS A total of 111 SEMSs and 153 PSs were placed with similar technical (100% vs. 98.69%) and functional success rate (90.10% vs. 86.27%) but with different stent patency (10.28 vs. 22.16 weeks; p < 0.001). Multiple PS implantations and larger stent diameter increased the length of stent patency compared to 7-Fr PSs (10.88 vs. 10.55 vs. 7.63 weeks, respectively). The cumulative treatment cost of patients with different survival times did not differ significantly between groups, however, among patients surviving 2-4 months it was higher in PS group than primary SEMS and secondary SEMS groups (2888€ vs. 2258€ vs. 2144€, respectively, p = 0.3369) due to increased number of biliary reintervention (2.08 ± 1.04 vs. 1.20 ± 0.42 vs. 1.50 ± 0.53; p < 0.0274) and longer hospital stay (15.77 ± 10.14 vs. 8.70 ± 7.70 vs. 8.50 ± 6.17 days, p = 0.0527). CONCLUSIONS In view of treatment costs, the consequences of illness, and the processes of the health care system, SEMS implantation is recommended regardless of patients' life expectancy.
Collapse
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725, Hungary.
| | - Anna Fábián
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Mónika Szűcs
- grid.9008.10000 0001 1016 9625Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Mariann Rutka
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Tibor Tóth
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - László Czakó
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Klaudia Farkas
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Norbert Buzás
- grid.9008.10000 0001 1016 9625Department of Health Economics, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Tamás Molnár
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Zoltán Szepes
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| |
Collapse
|
9
|
Resál T, Mangó K, Bacsur P, Szántó K, Pigniczki D, Keresztes C, Rutka M, Bálint A, Milassin Á, Bor R, Fábián A, Szepes Z, Farkas K, Monostory K, Molnár T. Possible genetical predictors of efficacy and safety of budesonide-MMX in patients with mild-to-moderate ulcerative colitis, and safety comparison with methylprednisolone. Expert Opin Drug Saf 2023; 22:517-524. [PMID: 36811412 DOI: 10.1080/14740338.2023.2181336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Budesonide-MMX is a topically active corticosteroid degraded by cytochrome-P450 enzymes, resulting in favorable side-effect profile. We aimed to assess the effect of CYP genotypes on safety and efficacy, and make a direct comparison with systemic corticosteroids. RESEARCH DESIGN AND METHODS We enrolled UC patients receiving budesonide-MMX and IBD patients on methylprednisolone in our prospective, observational-cohort study. Before and after treatment regimen clinical activity indexes, laboratory parameters (electrolytes, CRP, cholesterol, triglyceride, dehydroepiandrosterone, cortisol, beta-crosslaps, osteocalcin), and body composition measurements were assessed. CYP3A4 and CYP3A5 genotypes were determined in the budesonide-MMX group. RESULTS 71 participants were enrolled (budesonide-MMX: 52; methylprednisolone: 19). CAI decreased (p<0.05) in both groups. Cortisol decreased (p<0.001), and the level of cholesterol was elevated in both groups (p<0.001). Body composition altered only following methylprednisolone. Bone homeostasis (osteocalcin; p<0.05) and DHEA (p<0.001) changed more prominently after methylprednisolone. Glucocorticoid-related adverse events were more common following methylprednisolone treatment (47.4% compared to 1.9%). CYP3A5(*1/*3) genotype positively influenced efficacy, but not safety. Only one patient's CYP3A4 genotype differed. CONCLUSIONS CYP genotypes can affect the efficacy of budesonide-MMX; however, further studies would be needed with analyses of gene expression. Although budesonide-MMX is safer than methylprednisolone, due to glucocorticoid-related side effects, admission should require greater precaution.
Collapse
Affiliation(s)
- Tamás Resál
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Katalin Mangó
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Péter Bacsur
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Daniella Pigniczki
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Surgery, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Csilla Keresztes
- Department for Medical Communication and Translation Studies, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Katalin Monostory
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Tamás Molnár
- Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| |
Collapse
|
10
|
Bacsur P, Matuz M, Resál T, Miheller P, Szamosi T, Schäfer E, Sarlós P, Iliás Á, Szántó K, Rutka M, Bálint A, Milassin Á, Fábián A, Bor R, Szepes Z, Molnár T, Farkas K. Ustekinumab is associated with superior treatment persistence but not with higher remission rates versus vedolizumab in patients with refractory Crohn's disease: results from a multicentre cohort study. Therap Adv Gastroenterol 2022; 15:17562848221144349. [PMID: 36600684 PMCID: PMC9806440 DOI: 10.1177/17562848221144349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatment with antitumor necrosis factor alpha (anti-TNF-α) is safe and effective as first-line therapy; however, its efficacy is limited due to primary nonresponse (PNR) and secondary loss of response (LOR), resulting in treatment discontinuation in approximately 40%-50% of cases. Vedolizumab (VDZ) and ustekinumab (UST) therapies could be good alternatives in patient with anti-TNF failure; however, no head-to-head randomized comparison of these drugs as second- or third-line treatments has been made. OBJECTIVES This study aimed to assess the treatment persistence and comparative effectiveness of UST and VDZ in patients with refractory Crohn's disease (CD). DESIGN In this nationwide retrospective study, patients with CD on UST or VDZ maintenance therapy were enrolled. Clinical data at baseline, after induction, and at week 52 were obtained. METHODS Clinical and biochemical activities as well as corticosteroid-free remission (SFR) rates were assessed, while concomitant medications, comorbidities, hospitalizations, and surgeries were recorded during the follow-up to detect any predictors. RESULTS A total of 161 UST- and 65 VDZ-treated patients completed the follow-up. No significant difference in clinical or biochemical remission rates was observed after induction between the two treatment groups; however, clinical remission rate at week 52 was higher in UST group. UST showed superior drug persistence than VDZ (86.5%, 57.9%, p < 0.0001). The drug type was predictive of clinical SFR at week 52 [p = 0.011, odds ratio (OR) = 2.39 with UST]. Drug failure rates were higher for VDZ than those for UST (PNR rates: 21.54% and 4.97%, respectively, p < 0.001, OR = 8.267, p = 0.001). LOR and escalations were more common during UST treatment (61.5% versus 36.9%, p < 0.001; 64.2% versus 23.1%, p < 0.001). Hospital and surgical admission rates did not differ significantly. Only one adverse event occurred with VDZ at week 20, which led to drug cessation. CONCLUSIONS VDZ and UST were safe and effective for treating patients with CD in whom anti-TNF therapy failed. UST showed superior drug persistence than VDZ, but dose escalation was more frequent. Biologicals used in lower treatment lines resulted in better drug persistence.
Collapse
Affiliation(s)
- Péter Bacsur
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of
Pharmacy, University of Szeged, Szeged, Hungary
| | - Tamás Resál
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Pál Miheller
- Department of Surgery and Interventional
Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest,
Hungary
| | - Tamás Szamosi
- Department of Gastroenterology, Military
Hospital – State Health Centre, Budapest, Hungary
| | - Eszter Schäfer
- Department of Gastroenterology, Military
Hospital – State Health Centre, Budapest, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department
of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Ákos Iliás
- First Department of Medicine, Faculty of
Medicine, Semmelweis University, Budapest, Hungary
| | - Kata Szántó
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | | |
Collapse
|
11
|
Fábián A, Bor R, Tóth T, Bacsur P, Bálint A, Farkas K, Milassin Á, Molnár T, Resál T, Rutka M, Gelley A, Gyökeres T, Hagymási K, Kovalcsik Z, Kristóf T, Lombay B, Lovik K, Miheller P, Rácz I, Salló Z, Tomcsik Z, Varga M, Vincze Á, Szepes Z. Tápcsatornai endoszkópos eljárásokkal összefüggő infekciós kockázat a SARS-CoV-2-járvány idején. Orv Hetil 2022; 163:1814-1822. [DOI: 10.1556/650.2022.32633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022]
Abstract
Bevezetés: A COVID–19-pandémia jelentősen befolyásolta az
endoszkópos laboratóriumok működését. Az endoszkópos vizsgálatok nagy
vírusátviteli rizikójúnak számítanak. Célkitűzés: A
koronavírus-járványnak a magyarországi endoszkópos laborok működésére kifejtett
hatásának és az endoszkópos személyzet SARS-CoV-2-fertőzésben való
érintettségének felmérése a 2020-as évben. Módszerek: Országos
szintű, keresztmetszeti, kérdőíves tanulmányunk során magyarországi endoszkópos
laboratóriumok vezetőit kerestük meg online formában. Vizsgáltuk a 2020-ban
elvégzett felső és alsó tápcsatornai endoszkópiák számát a 2019-es
referenciaévhez viszonyítva (átlag [95%-os konfidenciaintervallum]), továbbá a
SARS-CoV-2-fertőzéssel érintett dolgozók számát és fertőződésük potenciális
forrását. Eredmények: A megkeresett intézmények 30%-ából
érkeztek válaszok (33/111). A referenciaévhez képest sem a felső (1593
[743–1514] vs. 1129 [1020–2166], p = 0,053), sem az alsó
tápcsatornai endoszkópos vizsgálatok száma (1181 [823–1538] vs.
871 [591–1150], p = 0,072) nem csökkent, bár a vírushullámoknak megfelelően
mindkét vizsgálattípus esetén 80%-ot meghaladó vizsgálatszám-csökkenést
tapasztaltunk. Dedikáltan fertőző betegek vizsgálatára kialakított helyiség az
intézetek 12%-ában állt rendelkezésre. A védőfelszerelések az első és a második
hullám alatt 70%-ban, illetve 82%-ban voltak mennyiségileg és minőségileg
megfelelőek. A vizsgálat előtt fertőzöttségirizikó-stratifikáció az intézetek
85%-ában, míg PCR-vizsgálat csupán 42%-ukban történt minden esetben. Az első és
második járványhullám alatt a dolgozói létszám az orvosoknál 33%-kal, illetve
26%-kal, az asszisztenseknél 19%-kal, illetve 21%-kal csökkent, elsősorban
életkori korlátozás, COVID-ellátásba való áthelyezés miatt. Az asszisztensek
32%-a, az orvosok 41%-a esett át COVID-fertőzésen, 16%-ban, illetve 18%-ban nem
megfelelő védőfelszerelés-használattal összefüggésben.
Következtetés: A járványhullámok alatti restrikciók
feloldását követően a vizsgálati terhelés emelkedik. A SARS-CoV-2-vakcinák
elérhetősége előtt az endoszkópos laborok dolgozóit érintő COVID-fertőzések
15%-a nem megfelelő védőfelszerelés-használattal volt összefüggésbe hozható. Orv
Hetil. 2022; 163(46): 1814–1822.
Collapse
Affiliation(s)
- Anna Fábián
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Renáta Bor
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tibor Tóth
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Péter Bacsur
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Anita Bálint
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Klaudia Farkas
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Ágnes Milassin
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tamás Molnár
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tamás Resál
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Mariann Rutka
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - András Gelley
- Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza Budapest Magyarország
| | - Tibor Gyökeres
- Magyar Honvédség Egészségügyi Központ, Gasztroenterológiai Osztály Budapest Magyarország
| | - Krisztina Hagymási
- Semmelweis Egyetem, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Zsolt Kovalcsik
- Tolna Megyei Balassa János Kórház, II. Belgyógyászati Osztály (Gasztroenterológia) Szekszárd Magyarország
| | - Tünde Kristóf
- Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház, II. Belgyógyászat-Gasztroenterológia Miskolc Magyarország
| | - Béla Lombay
- Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház, II. Belgyógyászat-Gasztroenterológia Miskolc Magyarország
| | | | - Pál Miheller
- Semmelweis Egyetem, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - István Rácz
- Petz Aladár Egyetemi Oktató Kórház Győr Magyarország
| | - Zoltán Salló
- Markhot Ferenc Oktatókórház és Rendelőintézet Eger Magyarország
| | - Zoltán Tomcsik
- Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Szent István Telephely, Sebészeti Osztály Budapest Magyarország
| | - Márta Varga
- Békés Megyei Központi Kórház, Dr. Réthy Pál Tagkórház, Gasztroenterológia Békéscsaba Magyarország
| | - Áron Vincze
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Sz. Belgyógyászati Klinika, Gasztroenterológiai Tanszék Pécs Magyarország
| | - Zoltán Szepes
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| |
Collapse
|
12
|
Resál T, Szántó K, Rutka M, Farkas K, Molnár T. Still the Joker in the Pack: When to Take Out Cyclosporine in the Game? Inflamm Bowel Dis 2021; 27:e95. [PMID: 33742654 PMCID: PMC10673650 DOI: 10.1093/ibd/izab066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Tamás Resál
- First Department of Medicine, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Faculty of Medicine, Szeged, Hungary
| |
Collapse
|
13
|
Resál T, Bor R, Szántó K, Fábián A, Rutka M, Sacco M, Ribaldone DG, Molander P, Nancey S, Kopylov U, Vavricka S, Drobne D, Lukas M, Farkas K, Szepes Z, Molnár T. Effect of COVID-19 pandemic on the workflow of endoscopy units: an international survey. Therap Adv Gastroenterol 2021; 14:17562848211006678. [PMID: 33995580 PMCID: PMC8072846 DOI: 10.1177/17562848211006678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to healthcare. Staff and patients are at increased risk during an examination or intervention, so certain restrictions ought to be introduced. Hence, we aimed to measure the effect of the pandemic on endoscopy units in real-life settings. METHODS This was an observational, cross-sectional, questionnaire-based study, carried out between 7 April and 15 June 2020. Responds came from many countries, and the participation was voluntary. The survey contained 40 questions, which evaluated the effect of the COVID-19 pandemic on the endoscopy units and assessed the infection control. RESULTS A total of 312 questionnaires were filled, 120 from Hungary, and 192 internationally, and 54 questionnaires (17.3%) were sent from high-risk countries; 84.9% of the gastroenterologists declared that they read the European Society of Gastrointestinal Endoscopy (ESGE) statement, while only 32.1% participated in any advanced training at their workplace. Overall, 92.1% of gastroenterologists realized risk stratification, and 72.1% claimed to have enough protective equipment. In 52.6% of the endoscopy units, at least one endoscopist had to discontinue the work due to any risk factor, while 40.6% reported that the reduced staff did not affect the workflow. Gastroenterologists considered that the five most important examinations both in low and high-risk patients are the following: lower/upper gastrointestinal (GI) bleeding with hemodynamic instability, endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice, foreign body in the esophagus, ERCP in acute biliary pancreatitis, and iron deficiency anemia with hemodynamic instability, which correlates well with the ESGE recommendation. Significant correlation was found in the usage of the necessary protective equipment in high-risk patients depending on the countries (p < 0.001). CONCLUSIONS The survey found weak correlation in preliminary training depending on countries; nevertheless, in Hungary during the examined period, endoscopists considered the recommendations more strictly than in other countries. Although many physicians left the endoscopy lab, the workflow was not affected, probably due to the reduced number of examinations.
Collapse
Affiliation(s)
- Tamás Resál
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Marco Sacco
- Endoscopy Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Torino, Piemonte, Italy
| | - Davide Guiseppe Ribaldone
- Department of Medical Sciences, Division of Gastroenterology, University of Turin, Turin, Piemonte, Italy
| | - Pauliina Molander
- Abdominal Center, Gastroenterology, Helsinki University Hospital, Helsinki, Finland
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon, University Claude Bernard Lyon and INSERM U1111, CIRI, Lyon, France
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan and Sackler Medical School, Tel Aviv University, Israel
| | | | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Milan Lukas
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Klaudia Farkas
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Gastroenterology Unit, Department of Medicine, University of Szeged, Szeged, Hungary
| | | |
Collapse
|
14
|
Farkas K, Pigniczki D, Rutka M, Szántó KJ, Resál T, Bor R, Fábián A, Szepes Z, Lázár G, Molnár T. The complex relationship between viruses and inflammatory bowel disease - review and practical advices for the daily clinical decision-making during the SARS-CoV-2 pandemic. Therap Adv Gastroenterol 2021; 14:1756284820988198. [PMID: 33953797 PMCID: PMC8044573 DOI: 10.1177/1756284820988198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/26/2020] [Indexed: 02/04/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak emerged in December 2019 in China and rapidly spread worldwide. Inflammatory bowel disease (IBD) patients are likely to be more susceptible to viral infections, and this is significantly influenced by the type of therapy they receive. Thus, issues specifically concerning the medical treatment of IBD patients were shortly addressed at the beginning of the pandemic. However, recently available data on the occurrence and outcome of SARS-CoV-2 infection in IBD patients does not address the concerns raised at the beginning of the pandemic. Growing evidence and the rapid changes happening over the past few weeks have helped elucidate the current situation, contribute to our understanding of the disease, and many previously raised questions could now be answered. We hereby summarise available evidence regarding viral infections and IBD, focusing on SARS-CoV infections, and we provide practical recommendations related to patient management during the COVID-19 pandemic era.
Collapse
Affiliation(s)
| | | | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Tamás Resál
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | |
Collapse
|
15
|
Rutka M, Pigniczki D, Molnár T. Tofacitinib Therapy, the Lender of Last Resort. J Crohns Colitis 2021; 15:694. [PMID: 32978625 DOI: 10.1093/ecco-jcc/jjaa198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Mariann Rutka
- Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Tamás Molnár
- Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
16
|
Judit Szántó K, Madácsy T, Kata D, Ferenci T, Rutka M, Bálint A, Bor R, Fábián A, Milassin Á, Jójárt B, Szepes Z, Nagy F, Molnár T, Földesi I, Maléth J, Farkas K. Advances in the optimization of therapeutic drug monitoring using serum, tissue and faecal anti-tumour necrosis factor concentration in patients with inflammatory bowel disease treated with TNF-α antagonists. Expert Opin Biol Ther 2021; 21:539-548. [PMID: 33583295 DOI: 10.1080/14712598.2021.1890712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The relationship between clinical outcomes and serum anti-TNF levels is controversial. The aim of this study was to perform simultaneous analyses of serum, mucosal, and fecal anti-TNF-α levels. METHODS Consecutive IBD patients who received maintenance anti-TNF-α therapy were enrolled. The number of TNF-α positive cells in the mucosa was detected using immunofluorescent labeling on biopsy samples. Serum, mucosal and fecal anti-TNF-α, serum anti-drug antibody, and fecal calprotectin levels were determined using ELISA. Each patient underwent body composition analysis as well. RESULTS Data of 50 patients were analyzed. The number TNF-α positive cells was significantly higher in the inflamed part of the colon than in the un-inflamed part of the colon. Tissue and fecal drug levels did not show any association with serum drug levels; moreover, serum anti-TNF concentration did not correlate with endoscopic activity. Mucosal anti-TNF levels were higher only in IFX-treated patients in remission and IFX-treated patients with detectable fecal anti-TNF had lower tissue drug levels. Presence of the drug in the feces was significantly different according to disease activity. CONCLUSION Fecal drug concentration is suggested to be a better predictor of endoscopic activity and loss of response, and fecal drug monitoring may improve the estimation accuracy of tissue drug levels.
Collapse
Affiliation(s)
| | - Tamara Madácsy
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Diána Kata
- Department of Laboratory Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Ferenci
- Physiological Controls Research Center, John von Neumann Faculty of Informatics, Institute of Biomatics, Óbuda University, Budapest, Hungary
| | - Mariann Rutka
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Zoltán Szepes
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Imre Földesi
- Department of Laboratory Medicine, University of Szeged, Szeged, Hungary
| | - József Maléth
- Department of Medicine, University of Szeged, Szeged, Hungary.,HCEMM-SZTE Molecular Gastroenterology Research Group, University of Szeged, Szeged, Hungary.,HAS-USZ Momentum Epithelial Cell Signalling and Secretion Research Group, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
17
|
Bor R, Szántó KJ, Fábián A, Farkas K, Szűcs M, Rutka M, Tóth T, Bálint A, Milassin Á, Dubravcsik Z, Szepes Z, Molnár T. Effect of COVID-19 pandemic on workflows and infection prevention strategies of endoscopy units in Hungary: a cross-sectional survey. BMC Gastroenterol 2021; 21:98. [PMID: 33657994 PMCID: PMC7927759 DOI: 10.1186/s12876-021-01670-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/16/2021] [Indexed: 02/08/2023] Open
Abstract
Background Health care professionals in endoscopic labs have an elevated risk for COVID-19 infection, therefore, we aimed to determine the effect of current pandemic on the workflow and infection prevention and control strategies of endoscopy units in real-life setting. Methods All members of Hungarian Society of Gastroenterology were invited between 7 and 17 April 2020 to participate in this cross-section survey study and to complete an online, anonymous questionnaire. Results Total of 120 endoscopists from 83 institutes were enrolled of which 35.83% worked in regions with high cumulative incidence of COVID-19. Only 33.33% of them had undergone training about infection prevention in their workplace. 95.83% of endoscopists regularly used risk stratification of patients for infection prior endoscopy. While indications of examinations in low risk patients varied widely, in high-risk or positive patients endoscopy was limited to gastrointestinal bleeding (95.00%), removal of foreign body from esophagus (87.50%), management of obstructive jaundice (72.50%) and biliary pancreatitis (67.50%). Appropriate amount of personal protective equipment was available in 60.85% of endoscopy units. In high-risk or positive patients, surgical mask, filtering facepiece mask, protective eyewear and two pairs of gloves were applied in 30.83%, 76.67%, 90.00% and 87.50% of cases, respectively. Personal protective equipment fully complied with European guideline only in 67.50% of cases. Conclusions Survey found large variability in indications of endoscopy and relative weak compliance to national and international practical recommendations in terms of protective equipment. This could be improved by adequate training about infection prevention.
Collapse
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary.
| | - Kata Judit Szántó
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tibor Tóth
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Zsolt Dubravcsik
- Department of Gastroenterology and Endoscopy, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | | | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| |
Collapse
|
18
|
Fábián A, Bor R, Szabó E, Kardos V, Bálint A, Farkas K, Milassin Á, Rutka M, Szántó K, Molnár T, Szűcs M, Lőrinczy K, Orbán-Szilágyi Á, Gyökeres T, Gyimesi G, Szepes A, Kovács V, Rácz I, Szepes Z. Endoscopic treatment of gastric antral vascular ectasia in real-life settings: Argon plasma coagulation or endoscopic band ligation? J Dig Dis 2021; 22:23-30. [PMID: 33128340 DOI: 10.1111/1751-2980.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/15/2020] [Accepted: 10/27/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The efficacy of argon plasma coagulation (APC) on gastric antral vascular ectasia (GAVE) may be impaired over time and depends greatly on the application settings. Endoscopic band ligation (EBL) may be an alternative, but study on its efficacy is limited. This study aimed to evaluate and compare the clinical efficacy of APC and EBL in treating GAVE. METHODS Changes in the need for blood transfusion, number of treatment sessions and hospitalizations were retrospectively assessed in 63 transfusion-dependent patients with GAVE (mean age: 67.1 y, 54.0% female) treated with either APC or EBL (45 and 18 patients, respectively) in four tertiary endoscopic centers. RESULTS Both methods substantially increased hemoglobin levels and decreased patients' need for a transfusion (22.0 ± 4.0 g/L and -5.62 ± 2.30 units of packed red blood cells [RBC] with APC, and 27.4 ± 6.1 g/L and -4.79 ± 2.46 units of packed RBC with EBL), without a significant statistical difference between the methods. However, fewer EBL sessions were required both for the cessation of need for a transfusion compared with those for the resolution of GAVE lesions (0.90 ± 0.10 vs 1.69 ± 0.31, P = 0.028). CONCLUSIONS Both APC and EBL are effective in GAVE treatment. EBL may be superior in terms of number of treatment sessions, but not in its influence on hemoglobin level and need for transfusion. Further prospective studies with large, homogeneous sample size and standardized APC settings are needed.
Collapse
Affiliation(s)
- Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ella Szabó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Viktor Kardos
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Katalin Lőrinczy
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Ákos Orbán-Szilágyi
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Tibor Gyökeres
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - György Gyimesi
- Department of Gastroenterology, Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary
| | - Attila Szepes
- Department of Gastroenterology, Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary
| | - Valéria Kovács
- Internal Medicine Department and Gastroenterology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - István Rácz
- Internal Medicine Department and Gastroenterology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
19
|
Bor R, Matuz M, Fabián A, Szepes Z, Szántó K, Farkas K, Rutka M, Milassin Á, Pigniczki D, Bálint A, Tóth T, Molnár T. Efficacy, tolerability and safety of a split-dose bowel cleansing regimen of magnesium citrate with sodium picosulfate - a phase IV clinical observational study. Rev Esp Enferm Dig 2020; 113:635-642. [PMID: 33371690 DOI: 10.17235/reed.2020.7073/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are contradictory results about the effect of magnesium citrate plus sodium picosulfate bowel cleansing agents on the fluid and electrolyte balance. Therefore, this study aimed to determine the efficacy, tolerability and safety of this medication in colonoscopy preparation. METHODS 233 patients were enrolled in this phase IV prospective observational study. The effectiveness of bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS). Adequate cleansing was defined as BBPS ≥ 6 and excellent cleansing as BBPS > 7. Tolerability was examined using a standardized questionnaire. In the safety analysis, the change of serum electrolytes levels and renal function during bowel cleansing was assessed. RESULTS Adequate and excellent bowel cleansing were achieved 94.85% and 72.96% of cases, respectively. None or very mild symptoms were reported in 47.21% of cases. Statistically significant changes occurred in serum potassium (4.38±0.43 vs. 4.25±0.43 mmol/L, p<0.0001), urea (4.86±1.37 vs. 3.84±1.43 mmol/L, p<0.0001) and creatinine (male: 81.07±16.02 vs. 84.54±15.11 μmol/L; female: 69.32±12.22 vs. 72.96±12.11 μmol/L, p<0.0001) levels during the colonoscopy preparation. However, the number of patients with values outside of the normal range increased significantly only in the case of serum urea (3.95% vs. 26.97%, p<0.0001). CONCLUSION Magnesium citrate with sodium picosulfate is outstandingly effective, well tolerated and a safe agent in colonoscopy preparation. It caused significant, but non-clinically relevant changes in serum electrolytes levels and renal function.
Collapse
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Hungary
| | | | - Anna Fabián
- First Department of Medicine, University of Szeged
| | | | - Kata Szántó
- First Department of Medicine, University of Szeged
| | | | | | | | | | - Anita Bálint
- First Department of Medicine, University of Szeged
| | - Tibor Tóth
- First Department of Medicine, University of Szeged
| | - Tamás Molnár
- First Department of Medicine, University of Szeged
| |
Collapse
|
20
|
Bacsur P, Skribanek S, Milassin Á, Farkas K, Bor R, Fábián A, Rutka M, Bálint A, Szántó KJ, Tóth T, Nagy F, Szepes Z, Boda K, Molnár T. Long-term follow-up of inflammatory bowel disease patients receiving anti-tumor necrosis factor-alpha therapy. Orv Hetil 2020; 161:1989-1994. [PMID: 33226355 DOI: 10.1556/650.2020.31913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: A gyulladásos bélbetegségek kezelésében a tumornekrózisfaktor-alfa-ellenes (anti-TNFα) antitestek elsődleges választási lehetőséget jelentenek a kortikoszteroid- és immunmoduláns kezelésre refrakter páciensek kezelési stratégiájában. Ezek a hatóanyagok hatékonyak, ám hosszú távú hatásosságukkal kapcsolatban sok az ellentmondás. Célkitűzés: Vizsgálatunk célja megvizsgálni az anti-TNFα-terápia (infliximab [IFX], adalimumab [ADA]) hosszú távú hatékonyságát gyulladásos bélbetegek körében. Módszerek: Retrospektív, adatgyűjtéses vizsgálatunkba a Szegedi Tudományegyetem I. Sz. Belgyógyászati Klinikáján gondozott, 18-65 év közötti gyulladásos bélbetegeket vontunk be. Az adatgyűjtést a Klinika informatikai rendszeréből végeztük a betegek ambuláns megjelenéseinek kezelőlapjaiból, illetve a zárójelentésekből. Eredmények: 102 beteg adatait elemeztük (Crohn-beteg: 67 fő, colitis ulcerosás: 35 fő). A Crohn-betegség diagnózisát követően átlagosan 7,84 év, a colitis ulcerosa diagnózisát követően átlagosan 9,86 év telt el az első anti-TNFα-terápia elkezdéséig. Az első kezelési ciklus átlagosan 2,64 évig tartott, a ciklus végén az IFX-t kapó betegek 50%-ánál, az ADA-t kapó betegek 46%-ánál volt remisszióban a betegség. A második kezelési ciklus átlagosan 4,67 évig tartott, a ciklus végén az IFX-t kapó betegek 36%-a, az ADA-t kapó betegek 40%-a volt remisszióban. Az első, illetve a második kezelési ciklus alatt az allergiás reakciók gyakorisága IFX esetében 13% és 18%, ADA esetében 4% és 3% volt. A primer hatástalanság és a másodlagos hatásvesztés az első ciklusban IFX esetében 4% és 10,5%, ADA esetében 11,5% és 19% volt. A második kezelési ciklusban IFX esetében 9%-ban és 18%-ban, ADA esetében 23%-ban és 10%-ban jelentették a ciklus végét. Következtetés: Az anti-TNFα-terápiák eredményeink alapján hosszú távon is hatékonynak és biztonságosnak bizonyultak. Másodlagos hatásvesztés kisebb arányban fordult elő a vizsgált populációban az irodalmi adatokhoz képest. Orv Hetil. 2020; 161(47): 1989-1994. SUMMARY INTRODUCTION Anti-tumor necrosis factor-alpha (anti-TNFα) treatment is reserved for steroid-dependent or steroid/immunomodulator-refractory inflammatory bowel diseases patients. These agents are effective, however, their long-term safety is still questionable. OBJECTIVE We aimed to assess the long-term efficacy and safety of two anti-TNFα therapies. METHODS In our retrospective study, we reviewed medical records via the administration system of the First Department of Medicine, University of Szeged. Female and male patients, aged between 18-65 years who received anti-TNFα therapy between 2010-2019 were enrolled. RESULTS 102 patients with inflammatory bowel disease were enrolled (Crohn's disease: 67, ulcerative colitis: 35). The first anti-TNFα therapy was introduced after an average 7.84 and 9.86 years from diagnosis of Crohn's disease and ulcerative colitis. The first treatment period lasted for 2.64 years; 50% of patients receiving IFX and 46% of patients receiving ADA were in remission at the end of the period. The second treatment period lasted for 4.67 years, 36% of IFX-treated patients and 40% of ADA-treated patients were in remission at the end of the period. 13% and 18% of patients treated by IFX and 4% and 3% of patients treated by ADA experienced infusion reaction during the first and the second treatment period. Primary non-response and loss of response rates were 4% and 10.5% (IFX) and 11.5% and 19% (ADA) during the first treatment period. These rates were 9% and 18% (IFX) and 23% and 10% (ADA) during the second treatment period. CONCLUSION Our study confirmed the long-term efficacy and safety of the anti-TNFα therapies. Loss of response rate is lower in our population compared to the literature. Orv Hetil. 2020; 161(47): 1989-1994.
Collapse
Affiliation(s)
- Péter Bacsur
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Soma Skribanek
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Ágnes Milassin
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Klaudia Farkas
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Renáta Bor
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Anna Fábián
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Mariann Rutka
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Anita Bálint
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Kata Judit Szántó
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Tibor Tóth
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Ferenc Nagy
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Szepes
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| | - Krisztina Boda
- 2 Általános Orvostudományi Kar, Orvosi Fizikai és Orvosi Informatikai Intézet, Szegedi Tudományegyetem, Szeged
| | - Tamás Molnár
- 1 Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Szeged, Korányi fasor 8-10., 6720
| |
Collapse
|
21
|
Bor R, Vasas B, Fábián A, Szűcs M, Füredi Á, Czakó L, Rutka M, Farkas K, Molnár T, Milassin Á, Bálint A, Szántó K, Hamar S, Kaizer L, Tiszlavicz L, Szepes Z. Slow-pull technique yields better quality smears: prospective comparison of slow-pull and standard suction techniques of endoscopic ultrasound-guided fine-needle aspiration. Scand J Gastroenterol 2020; 55:1369-1376. [PMID: 33016159 DOI: 10.1080/00365521.2020.1825792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diagnostic accuracy and quality of smears obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are influenced by characteristics of suction and examined organ. AIMS AND METHODS Efficiency of EUS-FNA and quality of smears obtained by slow-pull (SP) and standard suction (SS) techniques was prospectively compared in the sampling of pancreatic (N = 56) and extrapancreatic (N = 145) tumors. RESULTS SS technique resulted in a higher number of smear pairs both in pancreatic (1.74 vs. 3.19; p < 0.001) and extrapancreatic tumors (1.62 vs. 3.28; p < 0.001); however, it decreased the proportion of diagnostic smears (46.69% vs. 36.52%; p = 0.002 and 49.17% vs. 30.67%; p < 0.001) and increased the bloodiness (1.51 vs. 2.07; p < 0.001 and 1.48 vs. 2.05; p < 0.001). In pancreatic cancers, no difference was observed in terms of diagnostic accuracy (81.38% vs. 83.45%) and cellularity (1.44 vs. 1.27; p = 0.067); however, they were substantially higher in extrapancreatic tumors using SP technique (71.41% vs. 60.71% and 1.34 vs. 0.77; p < 0.001). Only SP technique resulted in a significant difference between examiners in terms of technical success rate and quality of smears without any decrease of diagnostic accuracy. CONCLUSIONS SP technique yields better quality smears independently from tumors characteristics; however, it shows significant examiner-dependency. SS technique reduces the diagnostic accuracy of sampling in extrapancreatic tumors.
Collapse
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Árpád Füredi
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Sándor Hamar
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - László Kaizer
- Department of Pathology, University of Szeged, Szeged, Hungary
| | | | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
22
|
Resál T, Pigniczki D, Szántó K, Rutka M, Farkas K, Molnar T. Letter: ciclosporin and vedolizumab for steroid-refractory ulcerative colitis. Aliment Pharmacol Ther 2020; 52:578-579. [PMID: 32656847 DOI: 10.1111/apt.15896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Tamás Resál
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Daniella Pigniczki
- Surgery Department, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Tamas Molnar
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| |
Collapse
|
23
|
Rutka M, Bor R, Molnár T, Farkas K, Pigniczki D, Fábián A, Györffy M, Bálint A, Milassin Á, Szücs M, Tiszlavicz L, Nagy F, Szepes Z. Efficacy of the population-based pilot colorectal cancer screening, Csongrád county, Hungary, 2015. Turk J Med Sci 2020; 50:756-763. [PMID: 32151116 PMCID: PMC7379438 DOI: 10.3906/sag-1908-79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/05/2020] [Indexed: 12/27/2022] Open
Abstract
Background/aim In Hungary, a nationwide colorectal screening program is about to be introduced in order to improve the high mortality rate of colorectal cancer (CRC). The aim was to summarize experiences from and assess short-term efficacy of the population- based pilot colorectal screening program in 2015 in Csongrád county, Hungary. Materials and methods Asymptomatic individuals between the ages of 50 and 70 with average risk of colorectal cancer participated in the program that was based on the two-step screening method: immune fecal blood test and colonoscopy. The short-term efficacy was assessed as the change in total CRC incidence and initial tumor stage in the screening year (2015). Results 22,130 individuals were invited to participate, and the participation rate was 46.4%. Immune fecal blood test proved to be nonnegative in 1,343 cases (13%), screening colonoscopy was performed in 766 of them (7.5%). Total colonoscopy was performed in 711 individuals. Based on the reports, adenoma was detected in 358 (50.3%) and malignancy in 42 (5.9%) individuals. In the background population, the incidence of colon cancer was higher (183 vs. 228; P = 0.026) and was diagnosed at earlier stage (P = 0.002), while lymph node involvement was lower in 2015 (48.3% vs. 37.1%; P = 0.049). Conclusion The Csongrád county population-based colorectal cancer screening was evidently successful on the short-term considering participation rate, and the changes in CRC incidence and stage, thus its national extension is necessary.
Collapse
Affiliation(s)
- Mariann Rutka
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Daniella Pigniczki
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Márk Györffy
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szücs
- Department of Medical Physics and Informatics, Faculty of Science and Informatics, Faculty of Medicine University of Szeged, Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Faculty of General Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
24
|
Resál T, Rutka M, Szántó K, Farkas K, Molnár T. The treatment of inflammatory bowel disease during the SARS-CoV-2 epidemic – practical advices: (A COVID–19-pandémia orvosszakmai kérdései). Orv Hetil 2020; 161:1022-1027. [PMID: 32516119 DOI: 10.1556/650.2020.31871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 11/19/2022]
Abstract
Patients with inflammatory bowel disease are more susceptible to severe viral infections requiring hospitalization regardless of treatment. Immunosuppressives and biological treatments multiply the chances of opportunistic and lung infections, especially in combination therapy, so due to the new coronavirus (severe acute respiratory syndrome coronavirus-2) epidemic, which primarily causes respiratory disease, it is advisable to use different therapeutic considerations for effective and safe patient care. Contrary to the expectations, a study from Italy and China each, despite of the large number of infected cases, did not report any SARS-CoV-2 positivity in patients with inflammatory bowel disease, which can be due to a number of favorable factors, such as the lower average age of the patients, lack of comorbidities, etc. However, it should not be forgotten that the patients on immunosuppressive and/or biological therapy belong to the compromised group. Consequently, in some cases there is a need to modify the therapy, but we should keep in mind that the relapse alongside with the need of medical consultation and even hospitalization elevate the chance of being infected. Thus, flare-ups ought to be avoided as far as they can be, so continuing the already started maintenance therapy can be a reasonable solution, but, in the high-risk group, modifying it can be reasonable as well. Our aim with this article is to make the health care more effective, and to give a practical recommendation for physicians during the epidemic, based on international publications. Orv Hetil. 2020; 161(25): 1022-1027.
Collapse
Affiliation(s)
- Tamás Resál
- Általános Orvostudományi Kar, I. Belgyógyászati Klinika,Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6725
| | - Mariann Rutka
- Általános Orvostudományi Kar, I. Belgyógyászati Klinika,Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6725
| | - Kata Szántó
- Általános Orvostudományi Kar, I. Belgyógyászati Klinika,Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6725
| | - Klaudia Farkas
- Általános Orvostudományi Kar, I. Belgyógyászati Klinika,Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6725
| | - Tamás Molnár
- Általános Orvostudományi Kar, I. Belgyógyászati Klinika,Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6725
| |
Collapse
|
25
|
Dulic S, Toldi G, Sava F, Kovács L, Molnár T, Milassin Á, Farkas K, Rutka M, Balog A. Specific T-Cell Subsets Can Predict the Efficacy of Anti-TNF Treatment in Inflammatory Bowel Diseases. Arch Immunol Ther Exp (Warsz) 2020; 68:12. [PMID: 32248339 PMCID: PMC7128008 DOI: 10.1007/s00005-020-00575-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Abstract
The effect of TNF-blockers on T-lymphocyte subsets is largely unknown in inflammatory bowel diseases (IBDs). The aim of the present study was to analyze the prevalence of T-cell subtypes and their correlation to therapeutic response. Sixty-eight patients with Crohn’s disease (CD), 46 with ulcerative colitis (UC) were enrolled. (1) The clinical course was followed after the initiation of TNF-blockers (prospective study). (2) The immunophenotype was also compared between long-term anti-TNF treated-responders and non-responders (cross-sectional study). The results were compared with those of therapy-naïve patients with active disease and those in remission with non-biological immunosuppressive therapy, and with healthy controls. Fourteen subtypes of peripheral blood T cells were measured with flow cytometry. The prevalence of Th2 and Th17 cells, of HLA-DR- and CD69-positive CD4 and CD8 cells, was higher, whereas the percentage of CD45RA-positive CD4 and CD8 cells was lower in both IBDs than in controls. CD8CD69 cell frequency was lower in remission, and decreased during anti-TNF therapy in CD responders. CD8CD45RO memory cells had higher prevalence in UC non-responders than in those starting anti-TNF. CD4CD45RO percentage < 49.05 at the initiation of TNF-blockers was predictive of a subsequent therapeutic response in CD, and Th2 and Th17 prevalence correlated with the duration of remission on TNF-blockers in UC. This study provided a detailed description of the T-cell composition in IBDs. CD8CD69 prevalence may be an activity marker in CD, and CD4CD45RO, Th2 and Th17 levels could be predictive for a therapeutic response to anti-TNF.
Collapse
Affiliation(s)
- Sonja Dulic
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Kálvária sgt. 57, Szeged, 6725, Hungary
| | - Gergely Toldi
- First Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Florentina Sava
- First Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - László Kovács
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Kálvária sgt. 57, Szeged, 6725, Hungary
| | - Tamás Molnár
- First Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Attila Balog
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Kálvária sgt. 57, Szeged, 6725, Hungary.
| |
Collapse
|
26
|
Szántó KJ, Rutka M, Pigniczki D, Farkas K, Burián K, Terhes G, Molnár T. Serological Status of Inflammatory Bowel Disease Patients Before Starting Biological Therapy - Data From a Tertiary Centre of the Best Vaccined Country. Inflamm Bowel Dis 2020; 26:e28. [PMID: 31974586 DOI: 10.1093/ibd/izaa005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
| | - Mariann Rutka
- Dept. of Medicine, University of Szeged, Szeged, Hungary
| | | | - Klaudia Farkas
- Dept. of Medicine, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary
| | - Gabriella Terhes
- Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Dept. of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
27
|
Bor R, Fábián A, Matuz M, Szepes Z, Farkas K, Miheller P, Szamosi T, Vincze Á, Rutka M, Szántó K, Bálint A, Nagy F, Milassin Á, Tóth T, Zsigmond F, Bajor J, Müllner K, Lakner L, Papp M, Salamon Á, Horváth G, Sarang K, Schäfer E, Sarlós P, Palatka K, Molnár T. Real-life efficacy of vedolizumab on endoscopic healing in inflammatory bowel disease – A nationwide Hungarian cohort study. Expert Opin Biol Ther 2019; 20:205-213. [PMID: 31782939 DOI: 10.1080/14712598.2020.1699529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Pál Miheller
- First Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Tamás Szamosi
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Áron Vincze
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Tóth
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Zsigmond
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Judit Bajor
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Katalin Müllner
- Second Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Mária Papp
- Second Department of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Gábor Horváth
- Central Hospital of Borsod-Abaúj-Zemplén County, Miskolc, Hungary
| | | | - Eszter Schäfer
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Patrícia Sarlós
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Károly Palatka
- Second Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
28
|
Pigniczki D, Rutka M, Farkas K, Molnar T. Lupus-like reactions in patients with inflammatory bowel disease: a little bit different data from another center. Scand J Gastroenterol 2019; 54:1498. [PMID: 31818162 DOI: 10.1080/00365521.2019.1690038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Daniella Pigniczki
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Tamas Molnar
- First Department of Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
| |
Collapse
|
29
|
Rencz F, Stalmeier PFM, Péntek M, Brodszky V, Ruzsa G, Gönczi L, Palatka K, Herszényi L, Schäfer E, Banai J, Rutka M, Gulácsi L, Lakatos PL. Patient and general population values for luminal and perianal fistulising Crohn's disease health states. Eur J Health Econ 2019; 20:91-100. [PMID: 31102158 PMCID: PMC6544586 DOI: 10.1007/s10198-019-01065-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/13/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND In patients with Crohn's disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Health utility values are not available from patients with CD that reflect the health loss associated with both luminal and perianal CD. OBJECTIVE To generate utilities for luminal and concomitant perianal fistulising CD health states directly from patients and from members of the general public. METHODS A cross-sectional survey was undertaken enrolling CD patients and a convenience sample of members of the general population. Respondents were asked to evaluate four common CD heath states [severe luminal disease (sCD), mild luminal disease (mCD), severe luminal disease with active perianal fistulas (sPFCD), and mild luminal disease with active perianal fistulas (mPFCD)] by 10-year time trade-off (TTO). In addition, patients assessed their current HRQoL by the TTO method. RESULTS Responses of 206 patients (40.8% with perianal fistulas) and 221 members of the general population were analysed. Mean ± SD utilities among patients for sPFCD, sCD, mPFCD and mCD states were 0.69 ± 0.33, 0.73 ± 0.31, 0.80 ± 0.29 and 0.87 ± 0.26. Corresponding values in the general public were: 0.59 ± 0.31, 0.65 ± 0.29, 0.80 ± 0.26 and 0.88 ± 0.25. Patients with active perianal fistulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse (p < 0.05). CONCLUSIONS TTO is a feasible method to assess HRQoL in patients with perianal fistulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fistulas.
Collapse
Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary.
- Premium Postdoctoral Research Program, Hungarian Academy of Sciences, Nádor u. 7, 1051, Budapest, Hungary.
| | - Peep F M Stalmeier
- Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Gábor Ruzsa
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University of Sciences, Izabella u. 46, 1064, Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Lóránt Gönczi
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, 1083, Budapest, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Nagyerdei krt. 98, 4032, Debrecen, Hungary
| | - László Herszényi
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - Eszter Schäfer
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - János Banai
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - Mariann Rutka
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720, Szeged, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, 1083, Budapest, Hungary
- Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| |
Collapse
|
30
|
Bor R, Vasas B, Fábián A, Bálint A, Farkas K, Milassin Á, Czakó L, Rutka M, Molnár T, Szűcs M, Tiszlavicz L, Kaizer L, Hamar S, Szepes Z. Prospective comparison of slow-pull and standard suction techniques of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of solid pancreatic cancer. BMC Gastroenterol 2019; 19:6. [PMID: 30626331 PMCID: PMC6327397 DOI: 10.1186/s12876-018-0921-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/10/2018] [Indexed: 12/13/2022] Open
Abstract
Background The usage of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of solid pancreatic cancer is increasing, however mainly retrospective studies are available about the detailed methods of sampling. Methods To compare prospectively the diagnostic yield of EUS-FNA samples obtained with slow-pull (SP) and with standard suction technique (SS). Results EUS-FNA sampling was diagnostic in 72 of 92 cases (78.3%). Diagnostic yield was 67.4% in the SS and 65.2% in the SP group. The number of smear pairs (1.84 vs. 3.56; p < 0.001) and blood contamination (1.50 vs. 2.19; p < 0.001) were significantly higher in the SS group, which resulted in lower rate of diagnostic samples (41.8% vs. 30.0%; p = 0.003). There was no difference in the cellularity (1.58 vs. 1.37; p = 0.2554), or in the sensitivity and specificity in the identification of malignancy between SP and SS subgroups (69.9, 100% vs. 73.5, 100%). Histological samples were obtained in 60 cases (with SP: 49 cases; with SS: 46 cases). There was no difference in the diagnostic yield of histological samples between the groups (63 and 58.7%). Conclusion The diagnostic yield, the cellularity of smears and the rate of acquiring sufficient histological material are similar in the SP and SS group, but due to lower bloodiness and decreased number of slides, the pathological diagnosis is faster and more cost-effective.
Collapse
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | | | - László Kaizer
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Sándor Hamar
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary.
| |
Collapse
|
31
|
Szántó K, Szűcs D, Vass N, Várkonyi Á, Bálint A, Bor R, Fábián A, Milassin Á, Rutka M, Szepes Z, Nagy F, Molnár T, Farkas K. [Transfer of care of adolescent inflammatory bowel disease patients without longitudinal transition. Lesson from 10 years experiences]. Orv Hetil 2018; 159:1789-1793. [PMID: 30392410 DOI: 10.1556/650.2018.31198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Transfer is a planned movement of patients and their medical records from one provider to another. Only a few data are available from real life in inflammatory bowel disease patients in this topic. AIM Our aim was to retrospectively evaluate the results of the transfer of our patients without longitudinal transition. METHOD Data of the transferred patients at the University of Szeged were analysed. Patients were diagnosed in paediatric care. Transfer strategy at our departments was detailed medical summary. RESULTS 59 patients were enrolled in this study. 28.8% of the patients had mild to moderate disease activity and 71.2% was in remission at the time of transfer. Steroid therapy was initiated in 58% of the patients within an average of 9.1 months after the transfer. Anti-tumor necrosis factor therapy was given to 24% of the patients during the paediatric care and to an additional 23% in the adult care within an average of 28 months. Almost 70% of the patients received immunosuppressive therapy during paediatric and adult care. Surgery was required in 17% of the patients within an average 10.7 months after the transfer. CONCLUSION Our results revealed that one-third of the paediatric patients have been transferred to adult care in active stage of disease. Shortly after the transfer 58% of the patients required corticosteroids and 17% surgery. Every fifth patient needed biological therapy to be initiated after the transfer. Longitudinal transition may have a potential to decrease the need for therapeutic change and the relatively high rate of surgery. Orv Hetil. 2018; 159(44): 1789-1793.
Collapse
Affiliation(s)
- Kata Szántó
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Dániel Szűcs
- Gyermekgyógyászati Klinika és Gyermek-egészségügyi Központ, Szegedi Tudományegyetem Szeged
| | - Noémi Vass
- Gyermekgyógyászati Klinika és Gyermek-egészségügyi Központ, Szegedi Tudományegyetem Szeged
| | - Ágnes Várkonyi
- Gyermekgyógyászati Klinika és Gyermek-egészségügyi Központ, Szegedi Tudományegyetem Szeged
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Anna Fábián
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Ferenc Nagy
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem Szeged, Korányi fasor 8-10., 6720
| |
Collapse
|
32
|
Bálint A, Rutka M, Kolar M, Bortlik M, Duricova D, Hruba V, Lukas M, Mitrova K, Malickova K, Lukas M, Szepes Z, Nagy F, Palatka K, Lovas S, Végh Z, Kürti Z, Csontos Á, Miheller P, Nyári T, Bor R, Milassin Á, Fábián A, Szántó K, Lakatos PL, Molnár T, Farkas K. Infliximab biosimilar CT-P13 therapy is effective in maintaining endoscopic remission in ulcerative colitis - results from multicenter observational cohort. Expert Opin Biol Ther 2018; 18:1181-1187. [PMID: 30277084 DOI: 10.1080/14712598.2018.1530758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND CT-P13, the first biosimilar monoclonal antibody to infliximab (IFX), has previously been confirmed to be efficacious in inducing mucosal healing in ulcerative colitis (UC) patients. The aim of this study was to evaluate the efficacy of CT-P13 therapy in maintaining mucosal healing in UC. METHODS CT-P13 trough levels, antibody positivity, serum inflammatory markers as CRP level, fecal calprotectin at weeks 14 and 54, concomitant steroid and azathioprine therapy at the time of induction therapy and at weeks 14 and 54, previous use of anti TNF drug and the need of dose intensification as possible predictive factors for mucosal healing at week 54 were evaluated in this prospective study. RESULTS 61 patients had already completed the 54-week treatment period. Mucosal healing was shown in 65.5 % and 62.1 %, complete mucosal healing was present in 31% and 38 % at week 14 and 54, respectively. The median values of CRP, leukocytes, thrombocytes, and albumin showed significant difference between baseline and week 54. Serum antibody positivity was proved in 6.5 % and 19.7 % of cases at week 14 and 54, respectively. CONCLUSION Our study confirmed the long-term efficacy of CT-P13 therapy on mucosal healing in UC.
Collapse
Affiliation(s)
- Anita Bálint
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Mariann Rutka
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Martin Kolar
- b IBD Clinical and Research Centre , Prague , Czech Republic.,c 1st Medical Faculty , Charles University , Prague , Czech Republic
| | - Martin Bortlik
- b IBD Clinical and Research Centre , Prague , Czech Republic.,d Department of Internal Medicine , Military Hospital, Charles University , Prague , Czech Republic
| | - Dana Duricova
- b IBD Clinical and Research Centre , Prague , Czech Republic.,e Institute of Pharmacology, 1st Medical Faculty , Charles University , Prague , Czech Republic
| | - Veronika Hruba
- b IBD Clinical and Research Centre , Prague , Czech Republic
| | - Martin Lukas
- b IBD Clinical and Research Centre , Prague , Czech Republic
| | - Katarina Mitrova
- b IBD Clinical and Research Centre , Prague , Czech Republic.,f Department of Paediatrics, Faculty Hospital Motol, 2nd Medical Faculty , Charles University , Prague , Czech Republic
| | - Karin Malickova
- b IBD Clinical and Research Centre , Prague , Czech Republic.,f Department of Paediatrics, Faculty Hospital Motol, 2nd Medical Faculty , Charles University , Prague , Czech Republic
| | - Milan Lukas
- b IBD Clinical and Research Centre , Prague , Czech Republic
| | - Zoltán Szepes
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Ferenc Nagy
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Károly Palatka
- g Institute of Medicine, Department of Gastroenterology , University of Debrecen, Clinical Center , Debrecen , Hungary
| | - Szilvia Lovas
- g Institute of Medicine, Department of Gastroenterology , University of Debrecen, Clinical Center , Debrecen , Hungary
| | - Zsuzsanna Végh
- h First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Zsuzsanna Kürti
- h First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Ágnes Csontos
- i Second Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Pál Miheller
- i Second Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Tibor Nyári
- j Department of Medical Physics and Informatics , University of Szeged , Szeged , Hungary
| | - Renáta Bor
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Ágnes Milassin
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Anna Fábián
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Kata Szántó
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Péter L Lakatos
- h First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Tamás Molnár
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Klaudia Farkas
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| |
Collapse
|
33
|
Szántó K, Nyári T, Bálint A, Bor R, Milassin Á, Rutka M, Fábián A, Szepes Z, Nagy F, Molnár T, Farkas K. Biological therapy and surgery rates in inflammatory bowel diseases - Data analysis of almost 1000 patients from a Hungarian tertiary IBD center. PLoS One 2018; 13:e0200824. [PMID: 30059523 PMCID: PMC6066221 DOI: 10.1371/journal.pone.0200824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/30/2018] [Indexed: 12/19/2022] Open
Abstract
Inflammatory bowel diseases (IBD) [Crohn’s disease (CD) and ulcerative colitis (UC)], are chronic relapsing disorders of unknown etiology. The aim of this study was to determine demographic features, disease phenotypes, medical and surgical therapies in our IBD patients and to identify which parameters are in association with the need of surgery and/or biologic therapy. Data on demographic and clinical characteristics of the patients were analyzed from the IBD registry of the 1st Department of Medicine, University of Szeged. The study period was between January 2007 and March 2015. Data of 911 IBD patients (428 CD, 483 UC) were analyzed. The median lag time between onset of symptoms and diagnosis proved to be significantly longer in UC than in CD (4.6 years vs. 2.1 years, p = 0.01). 40% of the patients received biological therapy, 301 patients underwent surgery required more frequently for CD than UC. Surgery was more common in CD patients with ileal location and penetrating behaviour. In UC, more severe disease onset predicted to unfavourable disease course. Higher proportion of surgery was shown in patient aged above 40 years in both CD and UC. Diagnostic delay of more than 1 year and appendectomy predicted to unfavourable disease outcome of both CD and UC. This analysis revealed that more than 1 year of diagnostic delay, disease activity at diagnosis in UC, CD, ileal location and penetrating behaviour are factors that may influence disease outcome. Use of thiopurines seemed to be protective in UC.
Collapse
Affiliation(s)
- Kata Szántó
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
- * E-mail:
| |
Collapse
|
34
|
Bálint A, Farkas K, Szepes Z, Nagy F, Szűcs M, Tiszlavicz L, Bor R, Milassin Á, Rutka M, Fábián A, Molnár T. How disease extent can be included in the endoscopic activity index of ulcerative colitis: the panMayo score, a promising scoring system. BMC Gastroenterol 2018; 18:7. [PMID: 29310593 PMCID: PMC5759871 DOI: 10.1186/s12876-017-0725-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/12/2017] [Indexed: 12/31/2022] Open
Abstract
Background Colonoscopy plays crucial role in the establishment of the diagnosis, management and follow-up of ulcerative colitis (UC). None of the currently widely used endoscopic scores consider disease extent, and therefore do not correlate with the real severity of UC. Our aim was to assess the accuracy of a new score, the Pancolonic Modified Mayo Score that can reflect not only the severity, but the extent of active UC. Methods One hundred and four UC patients were enrolled in this prospective study. The Endoscopic Mayo Scores of the involved area of the five colorectal segments were added; furthermore, the sum was multiplied by 3 in case of eMayo ≥2 (range 0 [normal] to 45 [most severe]) to obtain the Pancolonic Modified Mayo Score (panMayo) in order to clearly distinguish the active and inactive disease. We analysed the correlation of panMayo Score with eMayo and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and complicated disease outcome. We compared the endoscopic indices with serum and faecal inflammatory parameters and Riley Score. Results The panMayo Score correlated with eMayo and UCEIS. Every endoscopic score showed correlation with Riley Score, CRP, haemoglobin, haematocrit, serum iron, faecal MMP-9 and calprotectin and also predicted a complicated disease outcome. Only panMayo score correlated exclusively with the extent of UC. Conclusions We suggest that this new score gives additional information about disease extent besides disease activity with a strong correlation with laboratory parameters of inflammation and with the other widely used endoscopic indices.
Collapse
Affiliation(s)
- Anita Bálint
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Korányi fasor 9, Szeged, 6720, Hungary
| | - László Tiszlavicz
- Department of Pathology, University of Szeged, Állomás u. 2, Szeged, 6725, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary.
| |
Collapse
|
35
|
Rutka M, Molnár T, Bor R, Farkas K, Fábián A, Győrfi M, Bálint A, Milassin Á, Szűcs M, Tiszlavicz L, Nagy F, Szepes Z. [Efficacy of the population-based pilot colorectal screening program. Hungary, Csongrád county, 2015]. Orv Hetil 2017; 158:1658-1667. [PMID: 29037058 DOI: 10.1556/650.2017.30822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Hungary, a nationwide colorectal screening program is about to be introduced in order to improve the extremely high mortality rate of colorectal cancer (CRC). AIM The aim of our study was to summarize experiences and assess short-term efficacy of the population-based pilot colorectal screening program in 2015 in Csongrád County, Hungary. PATIENTS AND METHOD Asymptomatic individuals between the ages of 50 and 70 with average risk of colorectal cancer participated in the program that was based on the two-step screening method (i.e. immune fecal blood test and colonoscopy). The short-term efficacy of the screening program was assessed as the change in total CRC incidence and initial tumor stage in the screening year (2015) compared to a control year (2013) in Szeged and its surroundings. Participation rate, positive predictive value of the screening methods and tumor detection rate was assessed. RESULTS 22,130 individuals were invited, the participation rate was 46.4%. Immune fecal blood test proved to be non-negative in 1,343 cases (13%), screening colonoscopy was performed in 766 of them (7.5%). Total colonoscopy was performed in 711 individuals. Based on the reports, adenoma was detected in 358 (50.3%) and malignancy in 42 (5.9%) individuals. In the background population, the incidence of colon cancer was significantly higher (183 vs. 228; p = 0.026) and was diagnosed at significantly earlier stage (p = 0.002). Lymph node involvement was significantly lower in 2015 (48.3% vs. 37.1%; p = 0.049). CONCLUSION The Csongrád county population-based colorectal cancer screening was evidently successful on the short term considering participation rate, and the changes in CRC incidence and stage, thus its national extension is necessary. Orv Hetil. 2017; 158(42): 1658-1667.
Collapse
Affiliation(s)
- Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Anna Fábián
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Márk Győrfi
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Mónika Szűcs
- Orvosi Fizikai és Orvosi Informatikai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Tiszlavicz
- I. Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Ferenc Nagy
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| |
Collapse
|
36
|
Farkas K, Rutka M, Ferenci T, Nagy F, Bálint A, Bor R, Milassin Á, Fábián A, Szántó K, Végh Z, Kürti Z, Lakatos PL, Szepes Z, Molnár T. Infliximab biosimilar CT-P13 therapy is effective and safe in maintaining remission in Crohn's disease and ulcerative colitis - experiences from a single center. Expert Opin Biol Ther 2017; 17:1325-1332. [PMID: 28819991 DOI: 10.1080/14712598.2017.1363885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND CT-P13, the first biosimilar monoclonal antibody to infliximab (IFX), has been confirmed to be efficacious in inducing remission in inflammatory bowel diseases (IBD). The aim of this study was to evaluate the long-term efficacy and safety of CT-P13 therapy in Crohn's disease (CD) and ulcerative colitis (UC), and to identify predictors of sustained clinical response during a 54-week CT-P13 treatment period. PATIENTS AND METHODS Patients with CD and UC, who were administered CT-P13, were prospectively enrolled. Clinical response was assessed at week 14 and week 54. Predictive factors for disease outcome at week 54 were evaluated. RESULTS 57 CD and 57 UC patients were included; 55 CD and 49 UC patients completed the induction therapy and 50 CD and 46 UC patients completed the 54-week treatment period. Clinical remission was achieved in 65.5% of CD and 75.5% of UC patients at week 14. Rate of continuous clinical response was 51% in both CD and UC at week 54. None of the examined parameters were predictive to the clinical outcome neither in CD, nor in UC. CONCLUSION This study confirmed the long-term efficacy and safety of CT-P13 therapy in IBD. Response rates at week 54 were similar in CD and UC.
Collapse
Affiliation(s)
- Klaudia Farkas
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Mariann Rutka
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Tamás Ferenci
- b John von Neumann Faculty of Informatics of Óbuda University , Budapest , Hungary
| | - Ferenc Nagy
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Anita Bálint
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Renáta Bor
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Ágnes Milassin
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Anna Fábián
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Kata Szántó
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Zsuzsanna Végh
- c First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Zsuzsanna Kürti
- c First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Péter L Lakatos
- c First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Zoltán Szepes
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Tamás Molnár
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| |
Collapse
|
37
|
Gonczi L, Kurti Z, Rutka M, Vegh Z, Farkas K, Lovasz BD, Golovics PA, Gecse KB, Szalay B, Molnar T, Lakatos PL. Drug persistence and need for dose intensification to adalimumab therapy; the importance of therapeutic drug monitoring in inflammatory bowel diseases. BMC Gastroenterol 2017; 17:97. [PMID: 28789636 PMCID: PMC5549364 DOI: 10.1186/s12876-017-0654-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023] Open
Abstract
Background Therapeutic drug monitoring (TDM) aid therapeutic decision making in patients with inflammatory bowel disease (IBD) who lose response to anti-TNF therapy. Our aim was to evaluate the frequency and predictive factors of loss of response (LOR) to adalimumab using TDM in IBD patients. Methods One hundred twelve IBD patients (with 214 TDM measurements, CD/UC 84/28, male/female 50/62, mean age CD/UC: 36/35 years) were enrolled in this consecutive cohort from two referral centres in Hungary. Demographic data were comprehensively collected and harmonized monitoring strategy was applied. Previous and current therapy, laboratory data and clinical activity were recorded at the time of TDM. Patients were evaluated either at the time of suspected LOR or during follow-up. TDM measurements were determined by commercial ELISA (LISA TRACKER, Theradiag, France). Results Among 112 IBD patients, LOR/drug persistence was 25.9%/74.1%. The cumulative ADA positivity (>10 ng/mL) and low TL (<5.0 μg/mL) was 12.1% and 17.8% after 1 year and 17.3% and 29.5% after 2 years of adalimumab therapy. Dose intensification was needed in 29.5% of the patients. Female gender and ADA positivity were associated with LOR (female gender: p < 0.001, OR:7.8 CI 95%: 2.5–24.3, ADA positivity: p = 0.007 OR:3.6 CI 95%: 1.4–9.5). Conclusions ADA development, low TL and need for dose intensification were frequent during adalimumab therapy and support the selective use of TDM in IBD patients treated with adalimumab. ADA positivity and gender were predictors of LOR. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0654-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lorant Gonczi
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Vegh
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Barbara D Lovasz
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary.,Institute of Applied Health Sciences, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Krisztina B Gecse
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Balazs Szalay
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Tamas Molnar
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary. .,Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, 1650 Ave. Cedar, D16.173. 1, Montreal, QC, H3G 1A4, Canada.
| |
Collapse
|
38
|
Bor R, Fábián A, Bálint A, Farkas K, Szűcs M, Milassin Á, Czakó L, Rutka M, Molnár T, Szepes Z. Endoscopic management of complications of self-expandable metal stents for treatment of malignant esophageal stenosis and tracheoesophageal fistulas. Therap Adv Gastroenterol 2017; 10:599-607. [PMID: 28835774 PMCID: PMC5557190 DOI: 10.1177/1756283x17718408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/03/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection. METHODS We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation. RESULTS A total of 238 SEMS implantations were performed with 99.06% technical success and 1.26% procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62%) and in 55 cases (25.94%) repeated endoscopic procedures were required. Early reintervention 24-48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1-6; median 2), 13.58 weeks (range 1.5-48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3%) oral feeding of patients was made possible by endoscopic interventions. CONCLUSIONS In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.
Collapse
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | |
Collapse
|
39
|
Milassin Á, Sejben A, Tiszlavicz L, Reisz Z, Lázár G, Szűcs M, Bor R, Bálint A, Rutka M, Szepes Z, Nagy F, Farkas K, Molnár T. Analysis of risk factors - especially different types of plexitis - for postoperative relapse in Crohn’s disease. World J Gastrointest Surg 2017; 9:167-173. [PMID: 28824749 PMCID: PMC5545135 DOI: 10.4240/wjgs.v9.i7.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/25/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.
METHODS Data from all patients who underwent Crohn’s disease (CD)-related resection at the University of Szeged, Hungary between 2004 and 2014 were analyzed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after surgery, resection margins, neural fiber hyperplasia, submucosal and myenteric plexitis were evaluated as possible predictors of postoperative recurrence. Histological samples were analyzed blinded to the postoperative outcome and the clinical history of the patient. Plexitis was evaluated based on the appearance of the most severely inflamed ganglion or nerve bundle. Patients underwent regular follow-up with colonoscopy after surgery. Postoperative recurrence was defined on the basis of endoscopic and clinical findings, and/or the need for additional surgical resection.
RESULTS One hundred and four patients were enrolled in the study. Ileocecal, colonic, and small bowel resection were performed in 73.1%, 22.1% and 4.8% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Twenty-six patients underwent previous CD-related surgery. Forty-three point two percent of the patients were on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-tumor necrosis factor-alpha postoperative treatment. Postoperative recurrence occurred in 61.5% of the patients; of them 39.1% had surgical recurrence. 92.2% of the recurrences developed within the first five years after the index surgery. Mean disease duration for endoscopic relapse was 2.19 years. The severity of submucosal plexitis was a predictor of the need for second surgery (OR = 1.267, 95%CI: 1.000-1.606, P = 0.050). Female gender (OR = 2.21, 95%CI: 0.98-5.00, P = 0.056), stricturing disease behavior (OR = 3.584, 95%CI: 1.344-9.559, P = 0.011), and isolated ileal localization (OR = 2.671, 95%CI: 1.033-6.910, P = 0.043) were also predictors of postoperative recurrence. No association was revealed between postoperative recurrence and smoking status, postoperative prophylactic treatment and the presence of myenteric plexitis and relapse.
CONCLUSION The presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.
Collapse
|
40
|
Gonczi L, Vegh Z, Golovics PA, Rutka M, Gecse KB, Bor R, Farkas K, Szamosi T, Bene L, Gasztonyi B, Kristóf T, Lakatos L, Miheller P, Palatka K, Papp M, Patai Á, Salamon Á, Tóth GT, Vincze Á, Biro E, Lovasz BD, Kurti Z, Szepes Z, Molnár T, Lakatos PL. Prediction of Short- and Medium-term Efficacy of Biosimilar Infliximab Therapy. Do Trough Levels and Antidrug Antibody Levels or Clinical And Biochemical Markers Play the More Important Role? J Crohns Colitis 2017; 11:697-705. [PMID: 27838610 DOI: 10.1093/ecco-jcc/jjw203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/09/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Biosimilar infliximab CT-P13 received European Medicines Agency [EMA] approval in June 2013 for all indications of the originator product. In the present study, we aimed to evaluate the predictors of short- and medium-term clinical outcome in patients treated with the biosimilar infliximab at the participating inflammatory bowel disease [IBD] centres in Hungary. METHODS Demographic data were collected and a harmonised monitoring strategy was applied. Clinical and biochemical activities were evaluated at Weeks 14, 30, and 54. Trough level [TL] and anti-drug antibody [ADA] concentrations were measured by enzyme-linked immunosorbent assay [ELISA] [LT-005, Theradiag, France] at baseline at 14, 30 and 54 weeks and in two centres at Weeks 2 and 6. RESULTS A total of 291 consecutive IBD patients (184 Crohn's disease [CD] and 107 ulcerative colitis [UC]) were included. In UC, TLs at Week 2 predicted both clinical response and remission at Weeks 14 and 30 (clinical response/remission at Week 14: area under the curve [AUC] = 0.81, p < 0.001, cut-off: 11.5 μg/ml/AUC = 0.79, p < 0.001, cut-off: 15.3μg/ml; clinical response/remission at Week 30: AUC = 0.79, p = 0.002, cut-off: 11.5 μg/ml/AUC = 0.74, p = 0.006, cut-off: 14.5 μg/ml), whereas ADA positivity at Week 14 was inversely associated with clinical response at Week 30 [58.3% vs 84.8% ,p = 0.04]. Previous anti-tumour necrosis factor [TNF] exposure was inversely associated with short-term clinical remission [Week 2: 18.8% vs 47.8%, p = 0.03, at Week 6: 38.9% vs 69.7%, p = 0.013, at Week 14: 37.5% vs 2.5%, p = 0.06]. In CD, TLs at Week 2 predicted short-term [Week 14 response/remission, AUCTLweek2 = 0.715-0.721, p = 0.05/0.005] but not medium-term clinical efficacy. In addition, early ADA status by Week 14 [p = 0.04-0.05 for Weeks 14 and 30], early clinical response [p < 0.001 for Weeks 30/54] and normal C-reactive protein [CRP] at Week 14 [p = 0.005-0.0001] and previous anti-TNF exposure [p = 0.03-0.0001 for Weeks 14, 30, and 54] were associated with short-and medium-term clinical response and remission. CONCLUSIONS In UC, early TLs were predictive for short- and medium-term clinical efficacy, whereas in CD, Week 2 TLs were associated only with short-term clinical outcomes.
Collapse
Affiliation(s)
- Lorant Gonczi
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Vegh
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Anna Golovics
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Renata Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Szamosi
- Military Hospital - State Health Centre, Budapest, Hungary
| | - László Bene
- First Department of Medicine, Peterfy Hospital, Budapest, Hungary
| | - Beáta Gasztonyi
- Second Department of Medicine, Zala County Hospital, Zalaegerszeg, Hungary
| | - Tünde Kristóf
- Second Department of Medicine, B-A-Z County and University Teaching Hospital, Miskolc, Hungary
| | - László Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary
| | - Pál Miheller
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Károly Palatka
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Mária Papp
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Árpád Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Ágnes Salamon
- Department of Gastroenterology, Tolna County Teaching Hospital, Szekszárd, Hungary
| | - Gábor Tamás Tóth
- Department of Gastroenterology, Janos Hospital, Budapest, Hungary
| | - Áron Vincze
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Edina Biro
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | | | - Zsuzsanna Kurti
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter L Lakatos
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| |
Collapse
|
41
|
Bálint A, Rutka M, Végh Z, Kürti Z, Gecse KB, Banai J, Bene L, Gasztonyi B, Kristóf T, Lakatos L, Miheller P, Palatka K, Patai Á, Salamon Á, Szamosi T, Szepes Z, Tóth GT, Vincze Á, Bor R, Milassin Á, Fábián A, Nagy F, Kolar M, Bortlik M, Duricova D, Hruba V, Lukas M, Mitrova K, Malickova K, Lukas M, Lakatos PL, Molnár T, Farkas K. Frequency and characteristics of infusion reactions during biosimilar infliximab treatment in inflammatory bowel diseases: results from Central European nationwide cohort. Expert Opin Drug Saf 2017; 16:885-890. [PMID: 28504555 DOI: 10.1080/14740338.2017.1323330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Végh
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kürti
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztina B. Gecse
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - János Banai
- Military Hospital – State Health Centre, Budapest, Hungary
| | - László Bene
- 1st Department of Medicine, Peterfy Hospital, Budapest, Hungary
| | - Beáta Gasztonyi
- 2nd Department of Medicine, Zala County Hospital, Zalaegerszeg, Hungary
| | - Tünde Kristóf
- 2nd Department of Medicine, B-A-Z County and University Teaching Hospital, Miskolc, Hungary
| | - László Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary
| | - Pál Miheller
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Károly Palatka
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Árpád Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Ágnes Salamon
- Department of Gastroenterology, Tolna County Teaching Hospital, Szekszárd, Hungary
| | - Tamás Szamosi
- Military Hospital – State Health Centre, Budapest, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Tamás Tóth
- Department of Gastroenterology, Janos Hospital, Budapest, Hungary
| | - Áron Vincze
- 1st Department of Medicine, University of Pécs, Pécs, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Martin Kolar
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Department of Internal Medicine, Military Hospital, Charles University, Prague, Czech Republic
| | - Dana Duricova
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Institute of Pharmacology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Veronika Hruba
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
| | - Martin Lukas
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
| | - Katarina Mitrova
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Department of Paediatrics, Faculty Hospital Motol, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Karin Malickova
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Milan Lukas
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Péter L. Lakatos
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
42
|
Milassin Á, Rutka M, Csontos ÁA, Miheller P, Palatka K, Szűcs M, Szepes Z, Bálint A, Bor R, Fábián A, Farkas K, Nagy F, Molnár T. What Is the Personal Experience of IBD Patients about Their Anti-TNF-Alpha Therapy? Health (London) 2017. [DOI: 10.4236/health.2017.97073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
43
|
Bálint A, Törőcsik D, Palatka K, Szepes Z, Szűcs M, Tamás F, Nagy F, Farkas K, Fábián A, Bor R, Milassin Á, Rutka M, Molnár T. Prognostic factors, effectiveness and safety of endoscopic balloon dilatation for de novo and anastomotic strictures in Crohn’s disease—A multicenter “real life” study. Cogent Medicine 2016. [DOI: 10.1080/2331205x.2016.1233687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Anita Bálint
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Dalma Törőcsik
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Károly Palatka
- 2nd Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szepes
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Ferenci Tamás
- Physiological Controls Group, John von Neumann Faculty of Informatics, Óbuda University, Budapest, Hungary
| | - Ferenc Nagy
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Klaudia Farkas
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Anna Fábián
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Renáta Bor
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Ágnes Milassin
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Mariann Rutka
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Tamás Molnár
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| |
Collapse
|
44
|
Farkas K, Chan H, Rutka M, Szepes Z, Nagy F, Tiszlavicz L, Nyári T, Tang W, Wong G, Tang R, Lo A, Cheung C, Wong S, Lui R, Molnár T, Ng SC. Gastroduodenal Involvement in Asymptomatic Crohn's Disease Patients in Two Areas of Emerging Disease: Asia and Eastern Europe. J Crohns Colitis 2016; 10:1401-1406. [PMID: 27282400 DOI: 10.1093/ecco-jcc/jjw113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/15/2016] [Accepted: 05/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The incidence of Crohn's disease [CD] is increasing in Asia and Eastern Europe. Limited studies have reported on the frequency of upper gastrointestinal [GI] involvement in patients with CD in non-Western countries. This prospective study compared the rate of macroscopic and microscopic upper GI manifestations and Helicobacter pylori positivity in asymptomatic CD patients in Asia and Eastern Europe. METHODS Consecutive asymptomatic CD patients were prospectively recruited for upper GI endoscopy between 2013 and 2015 in Hong Kong and in Hungary. Endoscopy and biopsy findings were recorded and histology was performed to assess for H. pylori and microscopic signs characteristic for CD, using standardized diagnostic criteria. RESULTS One hundred and eighty CD patients [100 Hong Kong; 80 Hungary; 70.6% male; mean age, 38.5 years] and 189 controls [100 Hong Kong; 89 Hungary; 57.7% male; mean age 41 years] were included. Gastroduodenal involvement of CD was significantly higher in Hungary than in Hong Kong [16.5% vs 2.0%, p ≤ 0.001]. H. pylori positivity was significantly higher in Hungarian than Chinese CD patients [13.9% vs 4.0%, p ≤ 0.001]. Granulomas were detected in 1% in Hong Kong and 7.6% in Hungary [p ≤ 0.001]. Chinese CD subjects had a significantly lower H. pylori positivity compared with controls [6% vs. 15%; p ≤ 0.001]. CONCLUSIONS Upper GI CD was significantly higher in Eastern Europe than in Asia. The detection of granuloma in Hungary was similar to the literature data, whereas focal gastritis was lower than expected in both cohorts.
Collapse
Affiliation(s)
- Klaudia Farkas
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Heyson Chan
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Mariann Rutka
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Whitney Tang
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Grace Wong
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Raymond Tang
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Angeline Lo
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Christina Cheung
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Sunny Wong
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Rashid Lui
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Tamás Molnár
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Siew C Ng
- Institute of Digestive Disease, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
45
|
Farkas K, Rutka M, Golovics PA, Végh Z, Lovász BD, Nyári T, Gecse KB, Kolar M, Bortlik M, Duricova D, Machkova N, Hruba V, Lukas M, Mitrova K, Malickova K, Bálint A, Nagy F, Bor R, Milassin Á, Szepes Z, Palatka K, Lakatos PL, Lukas M, Molnár T. Efficacy of Infliximab Biosimilar CT-P13 Induction Therapy on Mucosal Healing in Ulcerative Colitis. J Crohns Colitis 2016; 10:1273-1278. [PMID: 27106537 DOI: 10.1093/ecco-jcc/jjw085] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION CT-P13 is the first biosimilar to infliximab that has been approved for the same indications as its originator infliximab. No data are available on the effect of infliximab biosimilar on mucosal healing. The aim of this study was to evaluate the efficacy of CT-P13 induction therapy on mucosal healing in patients with ulcerative colitis [UC]. PATIENTS AND METHODS UC patients, who received CT-P13 therapy from its local introduction at three Hungarian and one Czech inflammatory bowel disease centres, were prospectively enrolled. Sigmoidoscopy was performed after the end of the induction therapy at week 14. Mucosal healing was defined as Mayo endoscopic subscore 0 or 1. Complete mucosal healing was defined as Mayo endoscopic subscore 0. Trough level of CT-P13 was measured at week 14. RESULTS Sixty-three UC patients who underwent CT-P13 induction therapy were enrolled in the study. Indication for the therapy was acute, severe flare up and chronic, refractory activity in 24 and 39 patients, respectively. Cumulative clinical response and steroid-free remission at week 14 were achieved in 82.5% and 47.6% of the patients, respectively. Sigmoidoscopy revealed steroid-free mucosal healing in 47.6% of the patients, and complete mucosal healing was present in 27%. Mayo endoscopic subscore decreased significantly at week 14 compared to baseline. Trough levels of infliximab correlated with mucosal healing. CONCLUSION This is, to our knowledge, the first study examining the efficacy of CT-P13 induction therapy on mucosal healing in UC. The results indicate that mucosal healing is achieved in two-thirds of UC patients by the end of the induction treatment with CT-P13.
Collapse
Affiliation(s)
- Klaudia Farkas
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Petra A Golovics
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Végh
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara D Lovász
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | | | - Martin Kolar
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,1 Medical Faculty, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Department of Internal Medicine, Military Hospital, Charles University, Prague, Czech Republic
| | - Dana Duricova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Institute of Pharmacology, 1 Medical Faculty, Charles University, Prague, Czech Republic
| | - Nadezda Machkova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Veronika Hruba
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Martin Lukas
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Katarina Mitrova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Department of Paediatrics, Faculty Hospital Motol, 2 Medical Faculty, Charles University, Prague, Czech Republic
| | - Karin Malickova
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1 Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Anita Bálint
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Károly Palatka
- 2 Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter L Lakatos
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Milan Lukas
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Institute of Medical Biochemistry and Laboratory Diagnostics, 1 Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Tamás Molnár
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
46
|
Bor R, Farkas K, Bálint A, Szűcs M, Ábrahám S, Milassin Á, Rutka M, Nagy F, Milassin P, Szepes Z, Molnár T. Prospective Comparison of Magnetic Resonance Imaging, Transrectal and Transperineal Sonography, and Surgical Findings in Complicated Perianal Crohn Disease. J Ultrasound Med 2016; 35:2367-2372. [PMID: 27629757 DOI: 10.7863/ultra.15.09043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) and transrectal sonography are the two accepted imaging modalities for evaluation of perianal fistulas and abscesses. Transperineal sonography is a new technique that is easy to learn and can be performed at any time. The purpose of this study was to prospectively compare the diagnostic accuracy of MRI, transrectal sonography, and transperineal sonography with surgical findings in patients with perianal Crohn disease. METHODS All patients with perianal Crohn disease underwent MRI, transrectal sonography, and transperineal sonography within a few days before surgery. Fistulas were classified as simple (43.8%) or complex (52.2%) based on surgical findings. RESULTS Twenty-three patients with active perianal Crohn disease (12 women and 11 men; mean age, 29.9 years; current therapy: antibiotics, 69.6%; azathioprine, 56.5%; and biologics, 73.9%; previous surgery, 26.1%; and proportion of smokers, 39.1%) were included. Sensitivity values for MRI, transrectal sonography, and transperineal sonography for diagnosis of fistulas were 84.6%, 84.6%, and 100%, respectively. Transperineal sonography was more sensitive for diagnosis of perianal abscesses than MRI and transrectal sonography (100%, 58.8%, and 92.8%). CONCLUSIONS Transperineal sonography is a very accurate diagnostic method with outstanding sensitivity compared with MRI and transrectal sonography for evaluation of complicated perianal Crohn disease. Due to its simplicity and low cost, it is recommended that transperineal sonography be the first diagnostic modality in these cases.
Collapse
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Departments of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | | | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Milassin
- Department of Radiology, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
47
|
Fábián A, Bor R, Bálint A, Farkas K, Milassin Á, Rutka M, Tiszlavicz L, Nagy F, Molnár T, Szepes Z. [Neoadjuvant treatment as a limiting factor to rectal ultrasonography]. Orv Hetil 2016; 157:1193-7. [PMID: 27452069 DOI: 10.1556/650.2016.30432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rectal ultrasonography is a basic method for staging rectal cancer. Tissue changes after neoadjuvant treatment alter the accuracy of the method. AIM The aim of the authors was to assess the accuracy of rectal ultrasonography after preoperative chemo-radiotherapy compared to the initial staging accuracy. METHOD Rectal ultrasounds performed between 2006 and 2014 were assessed retrospectively. Ultrasonographic and pathological T and N stages were compared both in case of initial staging (control group) and re-staging. RESULTS T staging was accurate in 70% in the control group and in 61% in re-staging. Rate of overstaging was 31% after neoadjuvant treatment. None of the ypT0 cases were identified. N staging accuracy was 64% in the control group and 61% in re-staging. CONCLUSIONS Neoadjuvant treatment impairs the accuracy of rectal ultrasound. The role of re-staging with rectal ultrasonography is debatable in the assessment of the efficacy of oncological treatment and surgical planning. Orv. Hetil., 2016, 157(30), 1193-1197.
Collapse
Affiliation(s)
- Anna Fábián
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - László Tiszlavicz
- Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Ferenc Nagy
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| |
Collapse
|
48
|
Rutka M, Bálint A, Farkas K, Palatka K, Lakner L, Miheller P, Rácz I, Hegede G, Vincze Á, Horváth G, Szabó A, Nagy F, Szepes Z, Gábor Z, Zsigmond F, Zsóri Á, Juhász M, Csontos Á, Szűcs M, Bor R, Milassin Á, Molnár T. [Long-term adalimumab therapy in ulcerative colitis in clinical practice: result of the Hungarian multicenter prospective study]. Orv Hetil 2016; 157:706-711. [PMID: 27106726 DOI: 10.1556/650.2016.30429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Adalimumab was approved for the treatment of ulcerative colitis refractory to conventional therapy several years later than infliximab in Europe. Due to the relatively low remission rate observed in Ultra trials, data on the efficacy of adalimumab in ulcerative colitis are really helpful in the daily practice. AIM The aim of this study was to prospectively collect data on induction and maintenance adalimumab therapy in patients with ulcerative colitis treated in Hungarian centres. METHOD This prospective study collected data of all patients with ulcerative colitis treated with adalimumab in 10 Hungarian centres. The primary endpoints of the study were rates of remission, response and primary failure at week 12, and the rate of continuous clinical response, remission and loss of response at weeks 30, and 52. Secondary endpoints were endoscopic outcome at week 52 and comparison of the efficacy of adalimumab between treatment naive and infliximab-experienced patients. RESULTS 73 patients with active ulcerative colitis were enrolled in the study. 75.3% of the patients exhibited clinical response after the induction at week 12. The probability of maintaining adalimumab treatment was 48.6% at week 52 with a continuous clinical response in 92% of these patients. Mucosal healing was achieved in 48.1% of the patients at week 52. Dose intensification was performed in 17.6% of the patients. Minor side effects developed in 4% of the patients and 5.4% of the patients underwent colectomy during the 1-year treatment period. CONCLUSIONS These results coming from the real clinical setting demonstrate a favourable efficacy of adalimumab induction and maintenance therapy in patients with ulcerative colitis.
Collapse
Affiliation(s)
- Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Károly Palatka
- II. Belgyógyászati Klinika, Debreceni Tudományegyetem, Általános Orvostudományi Kar Debrecen
| | | | - Pál Miheller
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | | | - Gábor Hegede
- Péterfy Sándor Utcai Kórház-Rendelőintézet és Sürgősségi Központ Budapest
| | - Áron Vincze
- I. Belgyógyászati Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | | | | | - Ferenc Nagy
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Gábor
- Semmelweis Kórház és Egyetemi Oktatókórház Miskolc
| | | | | | - Márk Juhász
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Ágnes Csontos
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Mónika Szűcs
- Orvosi Fizika és Orvosi Informatika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| |
Collapse
|
49
|
Annaházi A, Ábrahám S, Farkas K, Rosztóczy A, Inczefi O, Földesi I, Szűcs M, Rutka M, Theodorou V, Eutamene H, Bueno L, Lázár G, Wittmann T, Molnár T, Róka R. A pilot study on faecal MMP-9: a new noninvasive diagnostic marker of colorectal cancer. Br J Cancer 2016; 114:787-92. [PMID: 26908323 PMCID: PMC4984857 DOI: 10.1038/bjc.2016.31] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 01/06/2016] [Accepted: 01/20/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Colorectal cancer (CRC) is one of the leading malignancies worldwide, therefore cheap noninvasive screening methods are of great importance. Matrix-metalloproteinase-9 (MMP-9) has a role in the progression of CRC, and its level is elevated in tumour biopsies. Faecal MMP-9 levels are increased in active ulcerative colitis patients, but in CRC patients, they have never been measured. We aimed to assess the faecal MMP-9 levels in patients undergoing total colonoscopy according to endoscopic and histological diagnosis. Methods: One hundred and nine patients provided faecal samples for MMP-9 analysis. A total colonoscopy was performed; suspicious lesions were evaluated by histology. Faecal MMP-9 levels were measured by ELISA. Results: The number of patients allocated to different groups were: negative/diverticulosis: 34 (referred to as controls); hyperplastic polyps: 15; adenomas: 32 (22 at high risk); and CRC: 28. Faecal MMP-9 was significantly increased in CRC compared with all other groups (P<0.001). Faecal MMP-9 was suitable to distinguish CRC patients from controls (sensitivity: 89.3% specificity: 91.2%). By means of a lower cutoff level, faecal MMP-9 identified high-risk adenomas besides CRC (sensitivity: 76% specificity: 85.3%). This lower cutoff level screened 59% of high-risk adenomas. Conclusions: Faecal MMP-9 may be a promising new noninvasive marker in CRC.
Collapse
Affiliation(s)
- Anita Annaházi
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Szabolcs Ábrahám
- Department of Surgery, University of Szeged, Pf. 427, Szeged 6701, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - András Rosztóczy
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Orsolya Inczefi
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Imre Földesi
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Korányi Fasor 9, Szeged 6720, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Vassilia Theodorou
- Toxalim UMR 1331 INRA/INP/UPS, Neuro-Gastroenterology and Nutrition Unit, 180, Chemin de Tournefeuille, BP.93173, Toulouse Cedex 3, 31027, France
| | - Helene Eutamene
- Toxalim UMR 1331 INRA/INP/UPS, Neuro-Gastroenterology and Nutrition Unit, 180, Chemin de Tournefeuille, BP.93173, Toulouse Cedex 3, 31027, France
| | - Lionel Bueno
- Toxalim UMR 1331 INRA/INP/UPS, Neuro-Gastroenterology and Nutrition Unit, 180, Chemin de Tournefeuille, BP.93173, Toulouse Cedex 3, 31027, France
| | - György Lázár
- Department of Surgery, University of Szeged, Pf. 427, Szeged 6701, Hungary
| | - Tibor Wittmann
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Richárd Róka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| |
Collapse
|
50
|
Daróczi T, Bor R, Fábián A, Szabó E, Farkas K, Bálint A, Czakó L, Rutka M, Szűcs M, Milassin Á, Molnár T, Szepes Z. [Cost-effectiveness trial of self-expandable metal stents and plastic biliary stents in malignant biliary obstruction]. Orv Hetil 2016; 157:268-74. [PMID: 26853728 DOI: 10.1556/650.2016.30365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Self-expandable metal and plastic stents can be applied in the palliative endoscopic treatment of patients with unresectable malignant biliary obstruction. The use of metal stentsis recommended if the patient's life expectancy is more than four months. AIM To compare the therapeutic efficacy and cost-effectiveness of metal and plastic stents in the treatment of malignant biliary obstruction. METHOD The authors retrospectively enrolled patients who received metal (37 patients) or plastic stent (37 patients). The complication rate, stent patency and cumulative cost of treatment were assessed in the two groups. RESULTS The complication rate of metal stents was lower (37.84% vs. 56.76%), but the stent patency was higher compared with plastic stents (19.11 vs. 8.29 weeks; p = 0.0041). In the plastic stent group the frequency of hospitalization of patients in context with stent complications (1.18 vs. 2.32; p = 0.05) and the necessity of reintervention for stent dysfunction (17 vs. 27; p = 0.033) were substantially higher. In this group multiple stent implantation raised the stent patency from 7.68 to 10.75 weeks. There was no difference in the total cost of treatment of malignant biliary obstruction between the two groups (p = 0.848). CONCLUSIONS Considering the cost of treatment and the burden of patients the authors recommend self-expandable metal sten timplantation if the life expectancy of patients is more than two months. In short survival cases multiple plastic stent implantation is recommended.
Collapse
Affiliation(s)
- Tímea Daróczi
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Anna Fábián
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Ella Szabó
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - László Czakó
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Mónika Szűcs
- Orvosi Fizika és Orvosi Informatika Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| |
Collapse
|