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Łukawska A, Ślósarz D, Zimoch A, Serafin K, Poniewierka E, Kempiński R. Cumulative Effective Dose from Medical Imaging in Inflammatory Bowel Disease. Diagnostics (Basel) 2021; 11:diagnostics11122387. [PMID: 34943623 PMCID: PMC8700332 DOI: 10.3390/diagnostics11122387] [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: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022] Open
Abstract
Inflammatory bowel diseases (IBD) are chronic and relapsing disorders usually requiring numerous medical imaging. IBD patients might be exposed to a large dose of radiation. As a cumulative effective dose (CED) ≥ 50 mSv is considered significant for stochastic risks of cancer, it is important to monitor the radiation exposure of IBD patients. In the present work, we aimed to quantify the mean CED in IBD patients and identify factors associated with exposure to high doses of diagnostic radiation. A retrospective chart view of patients with IBD hospitalized between 2015 and 2019 was performed. A total of 65 patients with Crohn's disease (CD) and 98 patients with ulcerative colitis (UC) were selected. Of all imaging studies performed, 73% were with doses of ionizing radiation. Mean CED (SD) amounted to 19.20 (15.64) millisieverts (mSv) and 6.66 (12.39) mSv, respectively, in patients with CD and UC (p < 0.00001). Only 1.84% of the patients received CED ≥ 50 mSv. We identified three factors associated with CED in the IBD patients: number of surgical procedures, and number and length of hospitalization. CD patients with strictures or penetrating disease and UC patients with extensive colitis were more likely to receive higher radiation doses.
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Affiliation(s)
- Agata Łukawska
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, 213 Borowska, 50–556 Wroclaw, Poland; (D.Ś.); (E.P.); (R.K.)
- Correspondence: ; Tel.: +48-71-733-21-20
| | - Dominika Ślósarz
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, 213 Borowska, 50–556 Wroclaw, Poland; (D.Ś.); (E.P.); (R.K.)
| | - Aneta Zimoch
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.Z.); (K.S.)
| | - Karol Serafin
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.Z.); (K.S.)
| | - Elżbieta Poniewierka
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, 213 Borowska, 50–556 Wroclaw, Poland; (D.Ś.); (E.P.); (R.K.)
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, 213 Borowska, 50–556 Wroclaw, Poland; (D.Ś.); (E.P.); (R.K.)
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Ślósarz D, Poniewierka E, Neubauer K, Kempiński R. Ultrasound Elastography in the Assessment of the Intestinal Changes in Inflammatory Bowel Disease-Systematic Review. J Clin Med 2021; 10:jcm10184044. [PMID: 34575156 PMCID: PMC8470999 DOI: 10.3390/jcm10184044] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 12/29/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic condition affecting primarily the gastrointestinal tract and characterized by growing incidence worldwide. Complex diagnostic process of IBD as well as evaluation of disease activity and intestinal complications that are crucial for the therapeutic decisions, require repetitive, invasive, expensive, time-consuming and poorly tolerated tests. In contrast to endoscopy and computed tomography, ultrasound elastography (UE) is non-invasive, non-radiating and non-contrasting dependent tool which might be utilized in IBD patients for the assessment of the intestinal changes. Therefore, we performed the systematic review to evaluate the possible application of the ultrasound elastography for assessment of the intestinal changes in IBD. After the search of three databases: PubMed, World of Knowledge and Scopus, we identified 12 papers which were included in the final analysis. The majority of the studies were focused on the evaluation of the symptomatic ileal/ileocolonic strictures in Crohn's disease patients that required surgical resection. Only one study concerned ulcerative colitis. The authors evaluated different UE techniques: strain elastography (SE), acoustic radiation force impulse (ARFI) and shear wave elastography (SWE). Results were expressed with semi-quantitative color mapping and strain measurement. Histological scores of inflammation and fibrosis in Crohn's disease were used as a reference test in the majority of studies. Ultrasound elastography seems to be a promising novel imaging technique supporting evaluation of the intestinal strictures in Crohn's disease patients in respect to fibrosis detection as well as differentiation between fibrosis and inflammation. However, further research is needed to establish the position of ultrasound elastography in IBD management.
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Feagan BG, Danese S, Loftus EV, Vermeire S, Schreiber S, Ritter T, Fogel R, Mehta R, Nijhawan S, Kempiński R, Filip R, Hospodarskyy I, Seidler U, Seibold F, Beales ILP, Kim HJ, McNally J, Yun C, Zhao S, Liu X, Hsueh CH, Tasset C, Besuyen R, Watanabe M, Sandborn WJ, Rogler G, Hibi T, Peyrin-Biroulet L. Filgotinib as induction and maintenance therapy for ulcerative colitis (SELECTION): a phase 2b/3 double-blind, randomised, placebo-controlled trial. Lancet 2021; 397:2372-2384. [PMID: 34090625 DOI: 10.1016/s0140-6736(21)00666-8] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The global prevalence of ulcerative colitis is increasing, and induction and maintenance of remission is a crucial therapeutic goal. We assessed the efficacy and safety of filgotinib, a once-daily, oral Janus kinase 1 preferential inhibitor, for treatment of ulcerative colitis. METHODS This phase 2b/3, double-blind, randomised, placebo-controlled trial including two induction studies and one maintenance study was done in 341 study centres in 40 countries. Eligible patients were aged 18-75 years with moderately to severely active ulcerative colitis for at least 6 months before enrolment (induction study A: inadequate clinical response, loss of response to or intolerance to corticosteroids or immunosuppressants, naive to tumour necrosis factor [TNF] antagonists and vedolizumab [biologic-naive]; induction study B: inadequate clinical response, loss of response to or intolerance to any TNF antagonist or vedolizumab, no TNF antagonist or vedolizumab use within 8 weeks before screening [biologic-experienced]). Patients were randomly assigned 2:2:1 to receive oral filgotinib 200 mg, filgotinib 100 mg, or placebo once per day for 11 weeks. Patients who had either clinical remission or a Mayo Clinic Score response at week 10 in either induction study entered the maintenance study. Patients who received induction filgotinib were rerandomised 2:1 to continue their induction filgotinib regimen or to placebo. Patients who received induction placebo continued receiving placebo. The primary endpoint was clinical remission by Mayo endoscopic, rectal bleeding, and stool frequency subscores at weeks 10 and 58. For the induction studies, efficacy was assessed in all randomised patients who received at least one dose of study drug or placebo within that study. For the maintenance study, efficacy was assessed in all patients randomised to any filgotinib treatment group in the induction studies who received at least one dose of study drug or placebo in the maintenance study. Patients who received placebo throughout the induction and maintenance study were not included in the full analysis set for the maintenance study. Safety was assessed in all patients who received at least one dose of the study drug or placebo within each study. This trial is registered with ClinicalTrials.gov, NCT02914522. FINDINGS Between Nov 14, 2016, and March 31, 2020, we screened 2040 patients for eligibility. 659 patients enrolled in induction study A were randomly assigned to receive filgotinib 100 mg (n=277), filgotinib 200 mg (n=245), or placebo (n=137). 689 patients enrolled into induction study B were randomly assigned to receive filgotinib 100 mg (n=285), filgotinib 200 mg (n=262), or placebo (n=142). 34 patients in induction study A and 54 patients in induction study B discontinued the study drug before week 10. After efficacy assessment at week 10, 664 patients entered the maintenance study (391 from induction study A, 273 from induction study B). 93 patients continued to receive placebo. 270 patients who had received filgotinib 100 mg in the induction study were randomly assigned to receive filgotinib 100 mg (n=179) or placebo (n=91). 301 patients who had received filgotinib 200 mg in the induction study were randomly assigned to receive filgotinib 200 mg (n=202) or placebo (n=99). 263 patients discontinued treatment in the maintenance study. At week 10, a greater proportion of patients given filgotinib 200 mg had clinical remission than those given placebo (induction study A 26·1% vs 15·3%, difference 10·8%; 95% CI 2·1-19·5, p=0·0157; induction study B 11·5% vs 4·2%, 7·2%; 1·6-12·8, p=0·0103). At week 58, 37·2% of patients given filgotinib 200 mg had clinical remission versus 11·2% in the respective placebo group (difference 26·0%, 95% CI 16·0-35·9; p<0·0001). Clinical remission was not significantly different between filgotinib 100 mg and placebo at week 10, but was significant by week 58 (23·8% vs 13·5%, 10·4%; 0·0-20·7, p=0·0420). The incidence of serious adverse events and adverse events of interest was similar between treatment groups. In the induction studies, serious adverse events occurred in 28 (5·0%) of 562 patients given filgotinib 100 mg, 22 (4·3%) of 507 patients given filgotinib 200 mg, and 13 (4·7%) of 279 patients given placebo. In the maintenance study, serious adverse events were reported in eight (4·5%) of 179 patients given filgotinib 100 mg, seven (7·7%) of 91 patients in the respective placebo group, nine (4·5%) of 202 patients in the filgotinib 200 mg group, and no patients in the respective placebo group. No deaths were reported during either induction study. Two patients died during the maintenance study; neither was related to treatment. INTERPRETATION Filgotinib 200 mg was well tolerated, and efficacious in inducing and maintaining clinical remission compared with placebo in patients with moderately to severely active ulcerative colitis. FUNDING Gilead Sciences.
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Affiliation(s)
- Brian G Feagan
- Alimentiv, London, ON, Canada; Division of Gastroenterology, London Health Sciences Centre, Western University, London, ON, Canada.
| | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | | | | | - Ronald Fogel
- Henry Ford Macomb Hospitals, Clinton Township, MI, USA
| | | | | | | | | | | | | | - Frank Seibold
- Crohn-Colitis Zentrum, Lindenhofspital, Bern, Switzerland
| | | | - Hyo Jong Kim
- Center for Crohn's and Colitis, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | - Gerhard Rogler
- University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France.
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Bromke MA, Neubauer K, Kempiński R, Krzystek-Korpacka M. Faecal Calprotectin in Assessment of Mucosal Healing in Adults with Inflammatory Bowel Disease: A Meta-Analysis. J Clin Med 2021; 10:jcm10102203. [PMID: 34069684 PMCID: PMC8161009 DOI: 10.3390/jcm10102203] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/01/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 12/12/2022] Open
Abstract
Achieving mucosal healing in patients with inflammatory bowel disease is related to a higher incidence of sustained clinical remission and it translates to lower rates of hospitalisation and surgery. The assessment methods of disease activity and response to therapy are limited and mainly rely on colonoscopy. This meta-analysis reviews the effectiveness of using faecal calprotectin as a marker for mucosal healing in inflammatory bowel disease. Two meta-analyses were conducted in parallel. The analysis on the use of faecal calprotectin in monitoring mucosal healing in colonic Crohn’s disease is based on 16 publications (17 studies). The data set for diagnostic values of faecal calprotectin in ulcerative colitis is composed of 35 original publications (total 49 studies). The DOR for the use of faecal calprotectin in Crohn’s disease is estimated to be 11.20 and the area under the sROCis 0.829. In cases of ulcerative colitis, the DOR is 14.48, while the AUC sROC is 0.858. Heterogeneity of the studies was moderatetosubstantial. Collected data show overall good sensitivity and specificity of the faecal calprotectin test, as well as a good DOR. Thus, monitoring of mucosal healing with a non-invasive faecal calprotectin test may represent an attractive option for physicians and patients with inflammatory bowel disease.
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Affiliation(s)
- Mariusz A. Bromke
- Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Chalubinskiego 10, 50-368 Wroclaw, Poland;
- Correspondence:
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (K.N.); (R.K.)
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (K.N.); (R.K.)
| | - Małgorzata Krzystek-Korpacka
- Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Chalubinskiego 10, 50-368 Wroclaw, Poland;
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Abstract
Inflammatory bowel diseases (IBD) are chronic, devastating conditions of the gastrointestinal tract characterized by a complex pathogenesis, increasing worldwide prevalence, a wide spectrum of extraintestinal manifestations, and a reduced health-related quality of life (HRQoL). Furthermore, mood disorders, specifically anxiety and depression, are more prevalent among IBD patients compared to the general population. The connection between mental disorders and IBD is compound, bidirectional and still not fully understood. The IBD may impact psychological health, whereas anxiety and depression are associated with a more aggressive course of IBD. The inflammation process, gut microbiota alterations and drug side effects are factors that influence the mental state of patients with IBD. Importantly, despite the high prevalence of depression and anxiety in IBD, many of the current guidelines do not include clear recommendation for assessment of mental problems in patients and further management. Therefore, monitoring for mood disorders should become a part of the multi-disciplinary and holistic approach to patients with IBD. This review is based on current literature searched in PubMed, mainly considering publications from the last 10 years.
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Affiliation(s)
- Paweł Kuźnicki
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
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Krzystek-Korpacka M, Szczęśniak-Sięga B, Szczuka I, Fortuna P, Zawadzki M, Kubiak A, Mierzchała-Pasierb M, Fleszar MG, Lewandowski Ł, Serek P, Jamrozik N, Neubauer K, Wiśniewski J, Kempiński R, Witkiewicz W, Bednarz-Misa I. L-Arginine/Nitric Oxide Pathway Is Altered in Colorectal Cancer and Can Be Modulated by Novel Derivatives from Oxicam Class of Non-Steroidal Anti-Inflammatory Drugs. Cancers (Basel) 2020; 12:E2594. [PMID: 32932854 PMCID: PMC7564351 DOI: 10.3390/cancers12092594] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
L-arginine/nitric oxide pathway metabolites are altered in colorectal cancer (CRC). We evaluated underlying changes in pathway enzymes in 55 paired tumor/tumor-adjacent samples and 20 normal mucosa using quantitative-PCR and assessed the impact of classic and novel oxicam analogues on enzyme expression and intracellular metabolite concentration (LC-MS/MS) in Caco-2, HCT116, and HT-29 cells. Compared to normal mucosa, ARG1, PRMT1, and PRMT5 were overexpressed in both tumor and tumor-adjacent tissue and DDAH2 solely in tumor-adjacent tissue. Tumor-adjacent tissue had higher expression of ARG1, DDAH1, and DDAH2 and lower NOS2 than patients-matched tumors. The ARG1 expression in tumors increased along with tumor grade and reflected lymph node involvement. Novel oxicam analogues with arylpiperazine moiety at the thiazine ring were more effective in downregulating DDAHs and PRMTs and upregulating ARG2 than piroxicam and meloxicam. An analogue distinguished by propylene linker between thiazine's and piperazine's nitrogen atoms and containing two fluorine substituents was the strongest inhibitor of DDAHs and PRMTs expression, while an analogue containing propylene linker but no fluorine substituents was the strongest inhibitor of ARG2 expression. Metabolic reprogramming in CRC includes overexpression of DDAHs and PRMTs in addition to ARG1 and NOS2 and is not restricted to tumor tissue but can be modulated by novel oxicam analogues.
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Affiliation(s)
- Małgorzata Krzystek-Korpacka
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Berenika Szczęśniak-Sięga
- Department of Medicinal Chemistry, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Izabela Szczuka
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Paulina Fortuna
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Marek Zawadzki
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland; (M.Z.); (W.W.)
- Department of Physiotherapy, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Agnieszka Kubiak
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Magdalena Mierzchała-Pasierb
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Mariusz G. Fleszar
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Łukasz Lewandowski
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Paweł Serek
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Natalia Jamrozik
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.N.); (R.K.)
| | - Jerzy Wiśniewski
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.N.); (R.K.)
| | - Wojciech Witkiewicz
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland; (M.Z.); (W.W.)
- Research and Development Centre at Regional Specialist Hospital, 51-124 Wroclaw, Poland
| | - Iwona Bednarz-Misa
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (I.S.); (P.F.); (A.K.); (M.M.-P.); (M.G.F.); (Ł.L.); (P.S.); (N.J.); (J.W.); (I.B.-M.)
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Krzystek-Korpacka M, Kempiński R, Bromke MA, Neubauer K. Oxidative Stress Markers in Inflammatory Bowel Diseases: Systematic Review. Diagnostics (Basel) 2020; 10:E601. [PMID: 32824619 PMCID: PMC7459713 DOI: 10.3390/diagnostics10080601] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 07/19/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Precise diagnostic biomarker in inflammatory bowel diseases (IBD) is still missing. We conducted a comprehensive overview of oxidative stress markers (OSMs) as potential diagnostic, differential, progression, and prognostic markers in IBD. A Pubmed, Web of Knowledge, and Scopus search of original articles on OSMs in IBD, published between January 2000 and April 2020, was conducted. Out of 874 articles, 79 eligible studies were identified and used to prepare the interpretative synthesis. Antioxidants followed by lipid peroxidation markers were the most popular and markers of oxidative DNA damage the least popular. There was a disparity in the number of retrieved papers evaluating biomarkers in the adult and pediatric population (n = 6). Of the reviewed OSMs, a promising performance has been reported for serum total antioxidant status as a mucosal healing marker, mucosal 8-OHdG as a progression marker, and for multi-analyte panels of lipid peroxidation products assessed non-invasively in breath as diagnostic and differential markers in the pediatric population. Bilirubin, in turn, was the only validated marker. There is a desperate need for non-invasive biomarkers in IBD which, however, will not be met in the near future by oxidative stress markers as they are promising but mostly at the early research phase of discovery.
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Affiliation(s)
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Mariusz A. Bromke
- Department of Medical Biochemistry, Wroclaw Medical University, Chałubińskiego 10, 50-368 Wroclaw, Poland;
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
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Krzystek-Korpacka M, Kempiński R, Bromke M, Neubauer K. Biochemical Biomarkers of Mucosal Healing for Inflammatory Bowel Disease in Adults. Diagnostics (Basel) 2020; 10:diagnostics10060367. [PMID: 32498475 PMCID: PMC7344443 DOI: 10.3390/diagnostics10060367] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
Mucosal healing (MH) is the key therapeutic target of inflammatory bowel disease (IBD). The evaluation of MH remains challenging, with endoscopy being the golden standard. We performed a comprehensive overview of the performance of fecal-, serum-, and urine-based biochemical markers in colonic IBD to find out whether we are ready to replace endoscopy with a non-invasive but equally accurate instrument. A Pubmed, Web of Knowledge, and Scopus search of original articles as potential MH markers in adults, published between January 2009 and March 2020, was conducted. Finally, 84 eligible studies were identified. The most frequently studied fecal marker was calprotectin (44 studies), with areas under the curves (AUCs) ranging from 0.70 to 0.99 in ulcerative colitis (UC) and from 0.70 to 0.94 in Crohn`s disease (CD), followed by lactoferrin (4 studies), matrix metalloproteinase-9 (3 studies), and lipocalin-2 (3 studies). The most frequently studied serum marker was C-reactive protein (30 studies), with AUCs ranging from 0.60 to 0.96 in UC and from 0.64 to 0.93 in CD. Fecal calprotectin is an accurate MH marker in IBD in adults; however, it cannot replace endoscopy and the application of calprotectin is hampered by the lack of standardization concerning the cut-off value. Other markers are either not sufficiently accurate or have not been studied extensively enough.
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Affiliation(s)
- Małgorzata Krzystek-Korpacka
- Department of Medical Biochemistry, Wroclaw Medical University, Chalubinskiego 10, 50-368 Wroclaw, Poland;
- Correspondence: (M.K.-K.); (K.N.)
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Mariusz Bromke
- Department of Medical Biochemistry, Wroclaw Medical University, Chalubinskiego 10, 50-368 Wroclaw, Poland;
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
- Correspondence: (M.K.-K.); (K.N.)
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Woźniak S, Kempiński R, Grzelak J, Domagała Z, Paulsen F. Anatomy-related ratios predict colonoscopy incompleteness in similar examination conditions. ADV CLIN EXP MED 2020; 29:573-580. [PMID: 32421261 DOI: 10.17219/acem/118847] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND Screening colonoscopy is one of the most popular modalities for screening and surveillance of colorectal cancer and other colon disorders. OBJECTIVES To introduce new ratios to predict the colonoscopy course in patients with similar characteristics. MATERIAL AND METHODS Five hundred screening colonoscopies (252 females and 248 males) were performed by an experienced endoscopist. Incomplete colonoscopies (without pathologic findings, i.e., disease-unrelated) were included in the study. Collected data was used to determine new ratios. RESULTS An examination was completed in 231 (91.7%) females (F) and 239 (96.4%) males (M). The majority of incomplete colonoscopies were discontinued in the sigmoid colon: 8 F (38.1%) and 4 M (44.4%) or in the descendosigmoid flexure: 4 F (19%) and 2 M (22.2%). We found statistically significant higher risk of incompleteness in females (p = 0.03), patients after 2 or more surgical treatments (p = 0.007) and in males with lower body mass index (BMI) (p = 0.01) (χ2 tests). Moreover, we discovered a statistically significant correlation with 2 or more previous surgical treatments in the female group (p = 0.02) (χ2 test). We calculated the incomplete colonoscopy anatomy-related (ICAR) and modified ICAR (MICAR) ratios. The range of ICAR and MICAR was 0-0.17; the number of incomplete examinations ranged from 0 to 1 failed out of 6 attempts (calculation: 100:17 = 5.88). CONCLUSIONS The ICAR and MICAR ratios reflect the various risk of colonoscopy incompleteness (i.e., disease-unrelated) and highlight the differences between patients in similar examination condition.
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Affiliation(s)
- Sławomir Woźniak
- Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Poland
| | - Radosław Kempiński
- 2nd Department and Clinic of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
- Medical Centre "Endomed", Wrocław, Poland
| | - Joanna Grzelak
- Department of Oral Anatomy, Wroclaw Medical University, Poland
| | - Zygmunt Domagała
- Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Krzystek-Korpacka M, G. Fleszar M, Bednarz-Misa I, Lewandowski Ł, Szczuka I, Kempiński R, Neubauer K. Transcriptional and Metabolomic Analysis of L-Arginine/Nitric Oxide Pathway in Inflammatory Bowel Disease and Its Association with Local Inflammatory and Angiogenic Response: Preliminary Findings. Int J Mol Sci 2020; 21:ijms21051641. [PMID: 32121248 PMCID: PMC7084352 DOI: 10.3390/ijms21051641] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/11/2022] Open
Abstract
L-arginine/nitric oxide pathway in Crohn's disease (CD) and ulcerative colitis (UC) is poorly investigated. The aim of current study is to quantify pathway serum metabolites in 52 CD (40 active), 48 UC (33 active), and 18 irritable bowel syndrome patients and 40 controls using mass spectrometry and at determining mRNA expression of pathway-associated enzymes in 91 bowel samples. Arginine and symmetric dimethylarginine decreased (p < 0.05) in active-CD (129 and 0.437 µM) compared to controls (157 and 0.494 µM) and active-UC (164 and 0.52 µM). Citrulline and dimethylamine increased (p < 0.05) in active-CD (68.7 and 70.9 µM) and active-UC (65.9 and 73.9 µM) compared to controls (42.7 and 50.4 µM). Compared to normal, CD-inflamed small bowel had downregulated (p < 0.05) arginase-2 by 2.4-fold and upregulated dimethylarginine dimethylaminohydrolase (DDAH)-2 (1.5-fold) and arginine N-methyltransferase (PRMT)-2 (1.6-fold). Quiescent-CD small bowel had upregulated (p < 0.05) arginase-2 (1.8-fold), DDAH1 (2.9-fold), DDAH2 (1.5-fold), PRMT1 (1.5-fold), PRMT2 (1.7-fold), and PRMT5 (1.4-fold). Pathway enzymes were upregulated in CD-inflamed/quiescent and UC-inflamed colon as compared to normal. Compared to inflamed, quiescent CD-colon had upregulated DDAH1 (5.7-fold) and ornithine decarboxylase (1.6-fold). Concluding, the pathway is deregulated in CD and UC, also in quiescent bowel, reflecting inflammation severity and angiogenic potential. Functional analysis of PRMTs and DDAHs as potential targets for therapy is warranted.
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Affiliation(s)
- Małgorzata Krzystek-Korpacka
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wrocław, Poland; (M.G.F.); (I.B.-M.); (Ł.L.); (I.S.)
- Correspondence: ; Tel.: +48-71-784-1375
| | - Mariusz G. Fleszar
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wrocław, Poland; (M.G.F.); (I.B.-M.); (Ł.L.); (I.S.)
| | - Iwona Bednarz-Misa
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wrocław, Poland; (M.G.F.); (I.B.-M.); (Ł.L.); (I.S.)
| | - Łukasz Lewandowski
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wrocław, Poland; (M.G.F.); (I.B.-M.); (Ł.L.); (I.S.)
| | - Izabela Szczuka
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wrocław, Poland; (M.G.F.); (I.B.-M.); (Ł.L.); (I.S.)
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, 50-556 Wrocław, Poland; (R.K.); (K.N.)
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, 50-556 Wrocław, Poland; (R.K.); (K.N.)
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11
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Kuliczkowski W, Gierlotka M, Tycińska A, Wojtkowska I, Zawiślak B, Zymliński R, Barylski M, Filipiak KJ, Mamcarz A, Szymański FM, Wożakowska-Kapłon B, Antoniewicz AA, Banasiak W, Budrewicz S, Depukat R, Gąsior M, Hobot J, Kempiński R, Mazurek B, Milejski W, Nowakowska-Kotas M, Oleksiuk J, Pomorski M, Rogalski P, Tajstra M, Tomaszuk-Kazberuk A, Zimmer M, Stępińska J. Management of bleeding in patients hospitalized in the intensive cardiac care unit: expert opinion of the Association of Intensive Cardiac Care and Section of Cardiovascular Pharmacotherapy of the Polish Cardiac Society in cooperation with specialists in other fields of medicine. Kardiol Pol 2019; 77:1206-1229. [PMID: 31815926 DOI: 10.33963/kp.15097] [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] [Indexed: 11/23/2022]
Abstract
Nowadays, the intensive cardiac care unit (ICCU) provides care for patients with acute coronary syndrome, acute and exacerbated chronic heart failure, cardiogenic shock, sudden cardiac arrest, electrical storm, as well as with indications for urgent cardiac surgical treatment. Most of these patients require the use of 1, 2, or frequently even 3 drugs that act on the blood coagulation pathway. While antithrombotic drugs prevent thromboembolic events, they are associated with a higher risk of bleeding. In this population of patients, bleeding may often have a worse impact on prognosis than the primary disease. In this expert opinion of the Association of Intensive Cardiac Care, we presented practical guidelines on the management of bleeding in patients hospitalized at the ICCU, including bleeding risk reduction and treatment recommendations. Because of multiple comorbidities and diverse organs that may be the source of bleeding, we provided also recommendations from specialists in other fields of medicine. We hope that this document will facilitate the management of one of the most challenging populations at the ICCU.
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Affiliation(s)
| | - Marek Gierlotka
- Department of Cardiology, University Hospital in Opole, University of Opole, Opole, Poland
| | - Agnieszka Tycińska
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Izabela Wojtkowska
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Barbara Zawiślak
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital Kraków, Kraków, Poland
| | - Robert Zymliński
- Center for Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Marcin Barylski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University ofLodz,Łódź, Poland
| | | | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Filip M Szymański
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Beata Wożakowska-Kapłon
- 1st Department of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Center, Kielce, Poland; Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Artur A Antoniewicz
- Department of Urology and Urologic Oncology, Międzyleski Specialist Hospital, Warsaw, Poland
| | - Waldemar Banasiak
- Center for Heart Diseases, Department of Cardiology, 4th Military Hospital, Wrocław, Poland
| | | | - Rafał Depukat
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital Kraków, Kraków, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jacek Hobot
- Department of General and Vascular Surgery, University Hospital in Opole, Opole, Poland
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wrocław, Poland
| | - Beata Mazurek
- Regional Center for Blood Donation and Blood Treatment in Kraków, Kraków, Poland
| | - Wojciech Milejski
- Department of Cardiology, University Hospital in Opole, University of Opole, Opole, Poland
| | | | - Jolanta Oleksiuk
- Department of Hematology with Vascular Disease Unit, Medical University of Bialystok, Białystok, Poland
| | - Michał Pomorski
- 2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Wrocław, Poland
| | - Paweł Rogalski
- Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Białystok, Poland
| | - Mateusz Tajstra
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Mariusz Zimmer
- 2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Wrocław, Poland
| | - Janina Stępińska
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
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12
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Kempiński R, Łukawska A, Krzyżanowski F, Ślósarz D, Poniewierka E. Clinical outcomes of non-alcoholic fatty liver disease: Polish-case control study. ADV CLIN EXP MED 2019; 28:1615-1620. [PMID: 31025557 DOI: 10.17219/acem/106173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/24/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is becoming the most common cause of chronic liver disease worldwide, affecting up to 30% of population. Non-alcoholic fatty liver disease can lead to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Age, obesity, insulin resistance, type 2 diabetes, and dyslipidemia are important risk factors for developing hepatic steatosis. Concomitant diseases, especially cardiovascular, are discussed as important causes of death in NAFLD patients. OBJECTIVES The objective of this study was to conduct a retrospective comparison of the frequency of concomitant diseases in NAFLD patients and controls, especially metabolic syndrome and cardiovascular disease (CVD). MATERIAL AND METHODS A total of 1,058 (558 NAFLD patients and 500 controls). Diagnosis of NAFLD was established with ultrasound examination in the absence of other causes of fatty liver. The control group included patients with no history of liver disease, normal liver image in ultrasound examination and normal liver laboratory tests. RESULTS Overweight and/or obesity were diagnosed in 80.8% of patients in the study group and 40.8% in the controls (p < 0.001). Metabolic syndrome was present in 48.7% patients in the study group compared with 14.4% controls, (p < 0.001). In the study group, we found higher prevalence of hypertension (56.1% vs 37%; p < 0.001), type 2 diabetes mellitus (24.4% vs 8.6%; p < 0.001), decreased concentration of serum HDL (35.1% vs 19.5%; p < 0.001), elevated serum triglycerides (36.5% vs 15.4%; p < 0.001). Cardiovascular disease was found in 13.6% of individuals in the study group and in 15% controls (NS, p = 0.32). The most frequent concomitant gastrointestinal disease present in the study group was gastroesophageal reflux disease (GERD) (31.9% vs 22.8%; p < 0.001) followed by colonic diverticulosis (23.7% vs 15.8%; p < 0.005). CONCLUSIONS Metabolic syndrome with its components is more common in NAFLD patients compared to matched controls. Additionally, NAFLD patients are more often affected by GERD and colonic diverticulosis but not by CVD.
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Affiliation(s)
- Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Agata Łukawska
- Gastroenterology Student Organization, Wroclaw Medical University, Poland
| | - Filip Krzyżanowski
- Gastroenterology Student Organization, Wroclaw Medical University, Poland
| | - Dominika Ślósarz
- Gastroenterology Student Organization, Wroclaw Medical University, Poland
| | - Elżbieta Poniewierka
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
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Kempiński R, Neubauer K, Hałoń A, Podgórski P, Dudkowiak R, Poniewierka E. Evaluation of adipose tissue and liver radiodensity in overweight or obese patients with nonalcoholic fatty liver disease. Pol Arch Intern Med 2019; 129:354-356. [PMID: 30793706 DOI: 10.20452/pamw.4457] [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: 11/23/2022]
Affiliation(s)
- Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wrocław, Poland
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wrocław, Poland
| | - Agnieszka Hałoń
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wrocław, Poland
| | - Przemysław Podgórski
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wrocław, Poland
| | - Robert Dudkowiak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wrocław, Poland
| | - Elżbieta Poniewierka
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wrocław, Poland
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14
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Poniewierka E, Neubauer K, Kempiński R, Sadakierska-Chudy A. Disease duration and age influence CARD15 expression in Crohn's disease. ACTA ACUST UNITED AC 2016; 70:10-3. [PMID: 26864060 DOI: 10.5604/17322693.1192187] [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] [Indexed: 11/13/2022]
Abstract
One of the susceptibility genes in Crohn's disease (CD) is CARD15. Our study examined the relationship between peripheral CARD15 expression and phenotype and duration of CD, treatment methods and inflammatory indices. Sixty patients with CD and 30 healthy volunteers as controls were enrolled in the study. Total RNA was isolated from peripheral blood mononuclear cells (PBMCs) with E.Z.N.A. Total RNA Kit (Omega Bio-tek) then quantitative real-time PCR was performed on the ABI Prism 7900 HT Real-Time PCR System. CARD15 gene expression in PBMCs in CD was significantly higher than in the control group. The highest level of gene expression was found in CD patients in the fourth decade of life. The mRNA level of the CARD15 gene was higher in patients with disease duration between 12 and 60 months. A positive correlation was found between erythrocyte sedimentation rate (ESR) and gene expression level. Gene expression increased with increasing level of C-reactive protein and ESR, but it was not statistically significant. CARD15 expression significantly decreased in CD patients treated with anti-TNFα agents compared to azathioprine or steroid treatment groups. Expression of the CARD15 gene in Crohn›s disease is higher than in healthy individuals. Disease duration and age of patients seem to be the most important factors influencing CARD15 expression.
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Affiliation(s)
- Elżbieta Poniewierka
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland, 50-556 Wroclaw, Borowska 213; Department of Gastroenterology and Hepatology. Dietetics Unit, Wroclaw Medical University
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland, 50-556 Wroclaw, Borowska 213
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland, 50-556 Wroclaw, Borowska 213
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15
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Kempiński R, Neubauer K, Wieczorek S, Dudkowiak R, Jasińska M, Poniewierka E. 13C-Methacetin Breath Testing in Patients with Non-Alcoholic Fatty Liver Disease. ADV CLIN EXP MED 2016; 25:77-81. [PMID: 26935501 DOI: 10.17219/acem/60878] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a very common chronic liver condition which may potentially develop into fibrosis and cirrhosis. Liver biopsy is still the gold standard for liver fibrosis detection in these patients. However, non-invasive tools for liver assessment in NAFLD patients, like the (13)C-methacetin breath test, may be useful. OBJECTIVES The aim of the study was to evaluate the utility of the (13)C-methacetin breath test in NAFLD patients, especially in predicting significant fibrosis. MATERIAL AND METHODS Thirty three patients (24 male and 9 female (average age 47.9)) with histologically proven NAFLD had the (13)C-methacetin breath test performed. RESULTS Different forms of NAFLD were found during the histology phase, from simple steatosis to advanced fibrosis. Simple steatosis (SS) was found in 18 subjects (54.5%), in another 15 (45.5%) signs of inflammation and fibrosis (NASH) were observed. However, more than half of the patients with liver fibrosis had only minimal changes described (0/1). The sensitivity of the test was highest for cumulative recovery after 10 min of the test and for a combination of two parameters (the cumulative recovery after 40 min and the time of maximal momentary recovery). The positive predictive value was low for all the parameters under consideration, but the negative predictive value was over 0.8 in significant fibrosis detection. CONCLUSIONS The (13)C-methacetin breath test could be a promising noninvasive tool for excluding at least F1 fibrosis in NAFLD patients.
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Affiliation(s)
- Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Szymon Wieczorek
- Department of Internal and Occupational Diseases and Hypertension, Wroclaw Medical University, Poland
| | - Robert Dudkowiak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Maria Jasińska
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Elżbieta Poniewierka
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
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16
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Biernat MM, Poniewierka E, Błaszczuk J, Czapla L, Kempiński R, Ksiądzyna D, Grabińska J, Bińkowska A, Megraud F, Gościniak G. Antimicrobial susceptibility of Helicobacter pylori isolates from Lower Silesia, Poland. Arch Med Sci 2014; 10:505-9. [PMID: 25097581 PMCID: PMC4107243 DOI: 10.5114/aoms.2013.36917] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 07/15/2012] [Accepted: 11/07/2012] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION In recent years the failure of standard therapy for Helicobacter pylori infections has been observed, which results primarily from the increasing resistance of H. pylori strains to antibiotics. The aim of the study was to estimate the prevalence of antimicrobial resistance of H. pylori strains isolated from adult symptomatic patients with primary infection in the Lower Silesia Region in Poland. MATERIAL AND METHODS One hundred and seventy-eight adults aged 19-89 years with dyspeptic symptoms suggesting gastroduodenal pathology were enrolled in the study. The study was performed in the years 2008-2011. Fifty H. pylori strains were isolated from gastric biopsy samples of examined patients. Antimicrobial susceptibility to 6 drugs (amoxicillin (AM), clarithromycin (CH), metronidazole (MZ), tetracycline (TC), levofloxacin (LEV), and rifabutin (RB)) was tested by the gradient-diffusion method (E-test method). RESULTS The incidence of H. pylori infection among examined patients was 35%. From 50 isolated H. pylori strains, 24% showed resistance to CH, 42% to MZ and 8% to LEV alone. Multidrug resistance was detected in 26% of strains, whereas 20% of isolates were resistant to MZ and CH. Examined strains were fully susceptible to AM, TC and RB. CONCLUSIONS Resistance to clarithromycin strains isolated from adults of the Lower Silesia Region in Poland is high and is almost always associated with resistance to metronidazole (CH + MZ). It is necessary to continuously monitor H. pylori resistance to drugs used in therapy, especially to clarithromycin. Verification of the existing recommendations of eradication therapy is also needed.
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Affiliation(s)
| | - Elżbieta Poniewierka
- Department and Clinic of Gastroenterology and Hepatology, Medical University of Wroclaw, Poland
| | - Jerzy Błaszczuk
- Department and Clinic of Gastrointestinal and General Surgery, Medical University of Wroclaw, Poland
| | - Leszek Czapla
- Department and Clinic of Gastrointestinal and General Surgery, Medical University of Wroclaw, Poland
| | - Radosław Kempiński
- Department and Clinic of Gastroenterology and Hepatology, Medical University of Wroclaw, Poland
| | - Dorota Ksiądzyna
- Department and Clinic of Gastroenterology and Hepatology, Medical University of Wroclaw, Poland
| | - Joanna Grabińska
- Department of Microbiology, Medical University of Wroclaw, Poland
| | - Aldona Bińkowska
- Department of Microbiology, Medical University of Wroclaw, Poland
| | - Francis Megraud
- Laboratoire de Bactériologie, C.H.U. Pellegrin, Bordeaux, France
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