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Alexdottir MS, Pehrsson M, Domislovic V, Godskesen LE, Krag A, Kjeldsen J, Brinar M, Barisic A, Bay-Jensen AC, Karsdal MA, Krznaric Z, Mortensen JH. Neutrophil-mediated type IV collagen degradation is elevated in patients with mild endoscopic ulcerative colitis reflecting early mucosal destruction. Sci Rep 2024; 14:1641. [PMID: 38238446 PMCID: PMC10796406 DOI: 10.1038/s41598-024-52208-y] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
Neutrophils play a significant role in sustaining chronic inflammation in Inflammatory Bowel Disease. The intestinal basement membrane acts as a barrier for immunological homeostasis, where the α3 and α4 chains of type IV collagen are expressed on the mucosal surface. We wanted to develop a biomarker reflecting early tissue injury, providing an opportunity for intervention. Two competitive enzyme-linked immunosorbent assays (ELISAs) quantifying human neutrophil elastase (HNE) degraded neo-epitopes of COL4A3 and COL4A4 were developed and investigated in two observational cohorts (n = 161, n = 100). A biomarker of MMP-mediated degradation of COL4A1 (C4M) was used for comparison. In Cohort 1, patients with mild endoscopic ulcerative colitis showed elevated levels of C4A3-HNE compared to those with severe disease. C4M had a strong positive correlation with disease activity. C4A3-HNE/C4M provided superior discrimination between mild and severe endoscopic disease and negatively correlated to disease activity. In Cohort 2, C4A4-HNE and C4A4-HNE/C4M showed similar trends. C4A3-HNE and C4A4-HNE possibly reflect early intestinal tissue injury. Combining the markers with a biomarker of another α-chain of the same collagen provides information on two distinct stages of mucosal damage. These biomarkers may be used to monitor disease flare-up in patients in remission, reducing the need for frequent endoscopic procedures.
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Affiliation(s)
- Marta S Alexdottir
- Department of Biomarkers and Research, Nordic Bioscience, 2370, Herlev, Denmark.
| | - Martin Pehrsson
- Department of Biomarkers and Research, Nordic Bioscience, 2370, Herlev, Denmark
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Line E Godskesen
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Denmark
| | - Aleksander Krag
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Denmark
| | - Jens Kjeldsen
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Denmark
| | - Marko Brinar
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Barisic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Morten A Karsdal
- Department of Biomarkers and Research, Nordic Bioscience, 2370, Herlev, Denmark
| | - Zeljko Krznaric
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Joachim H Mortensen
- Department of Biomarkers and Research, Nordic Bioscience, 2370, Herlev, Denmark
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Pehrsson M, Domislovic V, Alexdottir MS, Brinar M, Karsdal MA, Barisic A, Krznaric Z, Mortensen JH. Blood-Based Biomarkers Reflecting Protease 3 and MMP-12 Catalyzed Elastin Degradation as Potential Noninvasive Surrogate Markers of Endoscopic and Clinical Disease in Inflammatory Bowel Disease. J Clin Med 2023; 13:21. [PMID: 38202027 PMCID: PMC10779348 DOI: 10.3390/jcm13010021] [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: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Chronic inflammation in inflammatory bowel disease (IBD) triggers significant extracellular matrix remodeling, including elastin remodeling, leading to severe clinical complications. Novel methods to assess intestinal tissue destruction may act as surrogate markers of endoscopic disease activity, relieving patients of invasive endoscopy. We explored the noninvasive blood-based biomarkers ELP-3 and ELM-12, measuring elastin degradation in IBD. In a study involving 104 Crohn's disease (CD), 39 ulcerative colitis (UC), and 29 healthy donors, we assessed these biomarkers' association with endoscopic and clinical disease activity using ELISA. Patients were evaluated based on the SES-CD and CDAI for CD patients and modified MES and partial Mayo for UC patients. ELP-3 and ELM-12 were elevated in patients with IBD. Discerning CD patients in endoscopic remission and mild from moderate to severe, ELP-3 provided an AUC of 0.69 and ELM-12 an AUC of 0.73. The ELP-3 biomarker was associated with UC patients and provided the highest diagnostic power of 0.87 for remission vs. active clinical disease. The data suggest an association of ELP-3 with active CD and ELM-12 with endoscopic remission in CD patients. Additionally, ELP-3 could identify UC patients with active clinical disease from patients in remission. The noninvasive biomarkers ELP-3 and ELM-12 could be potential surrogate biomarkers of elastin degradation and endoscopic and clinical disease markers.
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Affiliation(s)
- Martin Pehrsson
- Biomarkers and Research, Nordic Bioscience A/S, 2730 Herlev, Denmark; (M.S.A.); (M.A.K.); (J.H.M.)
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.D.); (M.B.); (Z.K.)
| | | | - Marko Brinar
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.D.); (M.B.); (Z.K.)
| | - Morten Asser Karsdal
- Biomarkers and Research, Nordic Bioscience A/S, 2730 Herlev, Denmark; (M.S.A.); (M.A.K.); (J.H.M.)
| | - Ana Barisic
- Center for Clinical Nutrition, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Zeljko Krznaric
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.D.); (M.B.); (Z.K.)
| | - Joachim Høg Mortensen
- Biomarkers and Research, Nordic Bioscience A/S, 2730 Herlev, Denmark; (M.S.A.); (M.A.K.); (J.H.M.)
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Simsek C, Dugic A, Domislovic V, Te Groen M, Hadefi A, Kravchuk S, Porcari S, Sochnieva A, Sousa P, Acedo P. Young GI Angle: The young perspective of the UEG White Book 2 by the Friends of the UEG Young Talent Group. United European Gastroenterol J 2023; 11:911-918. [PMID: 37880151 PMCID: PMC10637121 DOI: 10.1002/ueg2.12478] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Affiliation(s)
- Cem Simsek
- Division of Gastroenterology, Hepatology and Endoscopy, Hacettepe University, Ankara, Turkey
| | - Ana Dugic
- Department of Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Maarten Te Groen
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
| | - Alia Hadefi
- Gastroenterology, Hôpital Erasme - ULB, Bruxelles, Belgium
| | | | - Serena Porcari
- Digestive Disease Center, Fondazione Policlinico Universitario 'A.Gemelli' - IRCCS, Monterotondo - Rome, Italy
| | - Anastasiia Sochnieva
- Department of Surgery No 1, Educational and Scientific Medical Instiute of the National Technical University "Kharkiv Polytechnic Institute", Kharkiv, Ukraine
| | - Paula Sousa
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Guimaraes, Portugal
| | - Pilar Acedo
- Institute for Liver & Digestive Health, University College London, London, UK
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Domislovic V, Krznaric Z, Heinrich H. Young GI angle: European Specialty Examination in Gastroenterology and Hepatology exam: Tips and tricks. United European Gastroenterol J 2023; 11:907-910. [PMID: 37861391 PMCID: PMC10637114 DOI: 10.1002/ueg2.12480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Affiliation(s)
- Viktor Domislovic
- Department of Gastroenterology and HepatologyUniversity Hospital Centre ZagrebZagrebCroatia
| | - Zeljko Krznaric
- Department of Gastroenterology and HepatologyUniversity Hospital Centre ZagrebZagrebCroatia
- University of ZagrebSchool of MedicineZagrebCroatia
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Staudacher JJ, Burisch J, Sousa P, Salaga M, Pellino G, Sidiropoulos O, Groen MT, Mandorfer M, Schwabl P, Straume Z, Bîrlog C, Dugic A, Simsek C, Jovanovic J, Kani HT, Qejvani O, Fennessy AM, Gorcheva Z, Kral J, Zanetto A, Duricek M, Domislovic V, Acedo P, Schlosser S. Young gastroenterologists angle: Friends of the UEG young talent group consensus statement on the structure of young gastroenterology sections. United European Gastroenterol J 2023. [PMID: 37357495 DOI: 10.1002/ueg2.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- Jonas Jaromir Staudacher
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Paula Sousa
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Maciej Salaga
- Department of Biochemistry, Medical University of Lodz, Lodz, Poland
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Maarten Te Groen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Philipp Schwabl
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Zane Straume
- Riga East Clinical University, Gastroenterology, Hepatology and Nutrition Clinic, Riga, Latvia
- Department of Internal Diseases, Riga Stradins University, Riga, Latvia
- Ogre Regional Hospital, Endoscopy Department, Ogre, Latvia
| | - Clarisa Bîrlog
- Ponderas Academic Hospital, Bucharest, Romania
- Young Taskforce, European Association of Endoscopic Surgeons, Eindhoven, The Netherlands
| | - Ana Dugic
- Department of Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Cem Simsek
- Department of Gastroenterology, Health Sciences University, Istanbul, Turkey
- Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Jelena Jovanovic
- Clinic for Gastroenterology, Department of Hepatology, University Centar of Serbia, Belgrade, Serbia
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Odri Qejvani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Anne M Fennessy
- Centre for Colorectal Diseases, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Ireland
| | - Zornica Gorcheva
- Medical University Pleven, Pleven, Bulgaria
- Department of Internal Diseases, UMBAL Sveta Marina Hospital, Pleven, Bulgaria
| | - Jan Kral
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Alberto Zanetto
- Gastroenterology and Multivisceral Transplant Unit, Padova University Hospital, Padua, Italy
| | - Martin Duricek
- Clinic of Internal Medicine - Gastroenterology, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Pilar Acedo
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK
| | - Sophie Schlosser
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Kalauz M, Cukovic Cavka S, Domislovic V, Pourmodjib K, Kalauz M, Dotlic S, Grubelic Ravic K, Krznaric Z. Diffuse intestinal ulcerations: Diagnostic challenge in a patient with complicated celiac disease. DEN Open 2023; 3:e140. [PMID: 35898850 PMCID: PMC9307732 DOI: 10.1002/deo2.140] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/30/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
Abstract
A 48‐year‐old female patient presented with longstanding unrecognized celiac disease (CD), a family history of CD, and a short duration of alarming symptoms. The diagnostic evaluation revealed the concomitant presence of small and large bowel ulcers raised a dilemma about differential diagnosis in her case. Pathologic examination of tissue specimens from the jejunal ulcer led to the diagnosis of enteropathy‐associated T‐cell lymphoma. In recent years, the availability of modern cross‐sectional imaging and endoscopy modalities has dramatically improved the detection and characterization of small bowel lesions. Characterization of small bowel ulcers by endoscopy and radiology imaging in a patient with suspected complicated CD (CCD) needs to be made in conjunction with all clinical factors, as there is a wide overlap of the possible etiologic factors. Enteropathy‐associated T‐cell lymphoma is a highly aggressive T‐cell lymphoma with a poor prognosis, since early diagnosis and appropriate treatment may be delayed due to nonspecific clinical and endoscopic presentation. Therefore, it is crucial to timely recognize patients with suspected CCD and properly navigate diagnostic imaging tools, acquire adequate biopsy, and perform immunophenotyping to set early diagnosis in patients with diffuse intestinal ulcers and CD.
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Affiliation(s)
- Mirjana Kalauz
- Department of Internal Medicine Division of Gastroenterology, Zagreb University Hospital Center School of Medicine University of Zagreb Zagreb Croatia
| | - Silvija Cukovic Cavka
- Department of Internal Medicine Division of Gastroenterology, Zagreb University Hospital Center School of Medicine University of Zagreb Zagreb Croatia
| | - Viktor Domislovic
- Department of Internal Medicine Division of Gastroenterology, Zagreb University Hospital Center School of Medicine University of Zagreb Zagreb Croatia
| | | | - Matija Kalauz
- School of Medicine University of Zagreb Zagreb Croatia
| | - Snjezana Dotlic
- Department of Pathology and Cytology Zagreb University Hospital Center, School of Medicine University of Zagreb Zagreb Croatia
| | - Katja Grubelic Ravic
- Department of Internal Medicine Division of Gastroenterology, Zagreb University Hospital Center School of Medicine University of Zagreb Zagreb Croatia
| | - Zeljko Krznaric
- Department of Internal Medicine Division of Gastroenterology, Zagreb University Hospital Center School of Medicine University of Zagreb Zagreb Croatia
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Domislovic V, Høg Mortensen J, Lindholm M, Kaarsdal MA, Brinar M, Barisic A, Manon-Jensen T, Krznaric Z. Inflammatory Biomarkers of Extracellular Matrix Remodeling and Disease Activity in Crohn’s Disease and Ulcerative Colitis. J Clin Med 2022; 11:jcm11195907. [PMID: 36233775 PMCID: PMC9572110 DOI: 10.3390/jcm11195907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/23/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Extracellular matrix (ECM) homeostasis is highly affected in active inflammatory bowel disease (IBD). The aim of the study was to investigate serological biomarkers of type III, IV, and V collagen degradation and formation, and their association with disease activity in IBD. ECM remodeling serum biomarkers were measured in 162 IBD patients, 110 with Crohn’s disease (CD) and 52 with ulcerative colitis (UC), and in 29 healthy donors. Biomarkers of type III collagen degradation (C3M) and formation (PRO-C3), type IV collagen degradation (C4M) and formation (PRO-C4), and type V collagen formation (PRO-C5) were measured using ELISA. Inflammatory activity was assessed using endoscopic, clinical, and biochemical activity indices. The highest diagnostic value was identified in discriminating endoscopically moderate to severe disease in CD (PRO-C3, C3M/PRO-C3, and C4M with AUC of 0.70, 0.73, and 0.69, respectively) and UC (C3M, C3M/PRO-C3, and C4M with AUC of 0.86, 0.80, and 0.76, respectively). C4M and C3M/PRO-C3 in combination yielded AUC of 0.93 (0.66–0.90) in CD and 0.94 (0.65–0.99) in UC. This study confirmed that ECM remodeling reflected disease activity in CD and UC. A combination of C4M, C3M, and PRO-C3 biomarkers may potentially be considered as a biomarker differentiating moderate to severe endoscopic disease.
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Affiliation(s)
- Viktor Domislovic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-992815000
| | | | - Majken Lindholm
- Biomarkers and Research, Nordic Bioscience A/S, 2730 Herlev, Denmark
| | | | - Marko Brinar
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ana Barisic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Tina Manon-Jensen
- Biomarkers and Research, Nordic Bioscience A/S, 2730 Herlev, Denmark
| | - Zeljko Krznaric
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Domislovic M, Domislovic V, Fucek M, Jelakovic A, Gellineo L, Dika Z, Jelakovic B. Should CKD EPI equation be used for estimation of glomerular filtration rate in obese subjects? Kidney Blood Press Res 2022; 47:597-604. [PMID: 36170804 DOI: 10.1159/000526115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/09/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Pandemic of obesity is strongly related to increase of chronic kidney disease (CKD) prevalence. Currently recommended CKD EPI equation has several serious limitations particularly in obese subjects who have high body surface area (BSA). The aim of our study was to analyze differences in the prevalence of CKD between CKD EPI and de-indexed equations where individual BSA was used. METHODS In total of 2058 subjects (random sample from general rural population, 29.65% obese) BSA was estimated using Dubois&Dubois and Moesteller equations and included into the de-indexed equations (CKD Di, CKD Mi). CKD was classified according to the KDIGO guidelines and glomerular hyperfiltration (GHF) was defined as 95th percentile according the gender and age decade. RESULTS In obese subjects, prevalence of CKD was significantly higher with CKD EPI than with CKD Di and CKD Mi equations (9.5%, 6.1%, 5.3%, respectively; p<0.001), while prevalence of GHF was significantly lower (3.8%, 12.3%, 12.8%, respectively; p<0.001). Opposite results were observed in subjects with BMI<25 kg/m2 for CKD (5%, 7.1%, 7.2%; p=0.07) and GHF prevalence (6.1%, 1%, 0.6%; p<0.001). DISCUSSION/CONCLUSIONS The prevalence of CKD is overestimated, and the prevalence of GHF is under-estimated in obese subjects using CKD EPI equation, i.e. CKD EPI equation is unreliable in one third of population. De-indexed equations should be recommended instead of CKD EPI equation in epidemiological studies until directly measurement of GFR become more available.
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Affiliation(s)
- Marija Domislovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirjana Fucek
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Jelakovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lana Gellineo
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zivka Dika
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Bojan Jelakovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
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Mikolasevic I, Domislovic V, Ruzic A, Hauser G, Rahelic D, Klobucar-Majanovic S, Krznaric Z, Dobrila-Dintinjana R, Grgurevic I, Skenderevic N, Lukic A, Targher G. Elastographic parameters of liver steatosis and fibrosis predict independently the risk of incident chronic kidney disease and acute myocardial infarction in patients with type 2 diabetes mellitus. J Diabetes Complications 2022; 36:108226. [PMID: 35803839 DOI: 10.1016/j.jdiacomp.2022.108226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/15/2022]
Abstract
AIMS The aim of this prospective study was to examine the relationship between controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) with the risk of developing a composite endpoint inclusive of incident acute myocardial infarction (AMI), cerebrovascular insult (CVI) or chronic kidney disease (CKD) in people with type 2 diabetes mellitus (T2DM). METHODS This study included 238 T2DM outpatients without chronic liver diseases. RESULTS The patient population was followed for a median period of 7.6 years. Kaplan-Meier survival analyses showed that there was a higher proportion of patients who developed the aforementioned composite outcome (P < 0.001 by the log-rank test), as well as CKD (P < 0.001) or AMI alone (P = 0.014) among those with elevated CAP values (≥238 dB/m) at baseline. Similarly, Kaplan-Meier survival analyses showed that there was a higher proportion of patients who developed the composite outcome (P < 0.001), as well as CKD (P < 0.001), or AMI alone (P < 0.001) among those with elevated LSM values (≥7.0/6.2 kPa). In multivariable regression analyses, the presence of elevated CAP (adjusted-hazard ratio 2.34, 95% CI 1.32-4.15) and elevated LSM (adjusted-hazard ratio 2.84, 95% CI 1.92-4.21), independently of each other, were associated with a higher risk of developing the composite outcome, as well as incident AMI or CKD alone after adjusting for traditional cardiovascular risk factors and diabetes-related variables. CONCLUSIONS Our study shows that the elastographic parameters of liver steatosis and fibrosis independently predict the long-term risk of developing chronic vascular complications in T2DM patients.
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Affiliation(s)
- I Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Faculty of Medicine, Rijeka, Croatia.
| | - V Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - A Ruzic
- Faculty of Medicine, Rijeka, Croatia; Clinic for Cardiology, University Hospital Center Rijeka, Rijeka, Croatia
| | - G Hauser
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Faculty of Medicine, Rijeka, Croatia; Faculty of Health Studies, Rijeka, Croatia
| | - D Rahelic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; University of Zagreb Faculty of Medicine, Zagreb, Croatia; University of Osijek Faculty of Medicine, Osijek, Croatia
| | - S Klobucar-Majanovic
- Faculty of Medicine, Rijeka, Croatia; Department for Diabetes, Endocrinology and Metabolic Diseases, UHC Rijeka, Croatia
| | - Z Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia; University of Zagreb Faculty of Medicine, Zagreb, Croatia
| | - R Dobrila-Dintinjana
- Faculty of Medicine, Rijeka, Croatia; Department of Oncology, UHC Rijeka, Croatia
| | - I Grgurevic
- University of Zagreb Faculty of Medicine, Zagreb, Croatia; Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia
| | - N Skenderevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - A Lukic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - G Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Italy
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Domislovic V, Brinar M, Cukovic-Cavka S, Turk N, Mikolasevic I, Krznaric Z. Prevalence, predictors and age-related sexual and erectile dysfunction in patients with inflammatory bowel disease: A tertiary centre experience. Int J Clin Pract 2021; 75:e14486. [PMID: 34107145 DOI: 10.1111/ijcp.14486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/01/2021] [Accepted: 05/29/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The impact of sexuality and quality of life (QOL) is one of the main concerns of IBD. Despite the obvious relevance of this problem, knowledge of the extent of sexual dysfunction (SD) in IBD is limited. Aim of this study was to assess the prevalence of SD and erectile dysfunction (ED), QOL their predictors, and their age-related dynamic in IBD patients. METHODS In this cross-sectional study, 202 IBD patients [122 male, 80 female, 133 Crohn's disease (CD), 69 ulcerative colitis (UC)] fulfilled International Index of Erectile Function (IIEF) or Female Sexual Functioning Index (FSFI). QOL was assessed using IBDQ-32 through bowel, systemic, emotional and social domains. RESULTS Prevalence of SD in men was 18%, ED 30.3% and SD in women 75%. Low QOL was present in 34.6% without gender difference (P = .253). In men, SD and ED were highest among 21-30 years and raising after 51 years of age. In women, SD was constantly highly prevalent, showing no decline over time. In multivariate analysis significant predictors of SD in men were CD phenotype, disease duration and emotional domain of IBDQ, of ED depression, emotional and bowel domain of IBDQ, and of SD in women emotional IBDQ domain. CONCLUSION Quality of sex life is a serious concern among IBD patients and is age related. Components that play a role in sexual functioning in IBD require more clarification and further development of screening and treatment guidelines for SD to provide better care in the IBD population.
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Affiliation(s)
- Viktor Domislovic
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marko Brinar
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Silvija Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Niksa Turk
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivana Mikolasevic
- Clinical Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Zeljko Krznaric
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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11
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Pariente B, Torres J, Burisch J, Arebi N, Barberio B, Duricova D, Ellul P, Goldis A, Kaimakliotis I, Katsanos K, Krznaric Ž, McNamara D, Pedersen N, Sebastian S, Azahaf M, Weimers P, Lung P, Lacognata C, Horak M, Christodoulou D, Domislovic V, Murphy I, Lambert J, Ungaro R, Colombel JF, Mary JY. Validation and Update of the Lémann Index to Measure Cumulative Structural Bowel Damage in Crohn's Disease. Gastroenterology 2021; 161:853-864.e13. [PMID: 34052277 PMCID: PMC8609534 DOI: 10.1053/j.gastro.2021.05.049] [Citation(s) in RCA: 22] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/15/2021] [Accepted: 05/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS The Lémann Index is a tool measuring cumulative structural bowel damage in Crohn's disease (CD). We reported on its validation and updating. METHODS This was an international, multicenter, prospective, cross-sectional observational study. At each center, 10 inclusions, stratified by CD duration and location, were planned. For each patient, the digestive tract was divided into 4 organs, upper tract, small bowel, colon/rectum, anus, and subsequently into segments, explored systematically by magnetic resonance imaging and by endoscopies in relation to disease location. For each segment, investigators retrieved information on previous surgical procedures, identified predefined strictures and penetrating lesions of maximal severity (grades 1-3) at each organ investigational method (gastroenterologist and radiologist for magnetic resonance imaging), provided segmental damage evaluation ranging from 0.0 to 10.0 (complete resection). Organ resection-free cumulative damage evaluation was then calculated from the sum of segmental damages. Then investigators provided a 0-10 global damage evaluation from the 4-organ standardized cumulative damage evaluations. Simple linear regressions of investigator damage evaluations on their corresponding Lémann Index were studied, as well as calibration plots. Finally, updated Lémann Index was derived through multiple linear mixed models applied to combined development and validation samples. RESULTS In 15 centers, 134 patients were included. Correlation coefficients between investigator damage evaluations and Lémann Indexes were >0.80. When analyzing data in 272 patients from both samples and 27 centers, the unbiased correlation estimates were 0.89, 0,97, 0,94, 0.81, and 0.91 for the 4 organs and globally, and stable when applied to one sample or the other. CONCLUSIONS The updated Lémann Index is a well-established index to assess cumulative bowel damage in CD that can be used in epidemiological studies and disease modification trials.
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Affiliation(s)
- Benjamin Pariente
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France.
| | - Joana Torres
- Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Johan Burisch
- Department of Gastroenterology, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark’s Hospital and Imperial College London, London, United Kingdom
| | - Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Dana Duricova
- Inflammatory Bowel Diseases Clinical and Research Center, ISCARE a.s., Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pierre Ellul
- Mater Dei Hospital, Department of Medicine, Division of Gastroenterology, Msida, Malta
| | - Adrian Goldis
- Department of Gastroenterology, University of Medicine, Timișoara, România
| | | | - Konstantinos Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Željko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Deirdre McNamara
- TAGG Research Centre, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Natalia Pedersen
- Department of Gastroenterology, Slagelse Hospital, Slagelse, Denmark
| | - Shaji Sebastian
- Inflammatory Bowel Diseases Unit, Hull University Teaching Hospitals National Health Service Trust, Hull, United Kingdom
| | - Mustapha Azahaf
- Radiology Department, Claude Huriez hospital, University of Lille, Lille, France
| | - Petra Weimers
- Department of Gastroenterology, North Zealand University Hospital, Capital Region, Denmark
| | - Philip Lung
- Radiology Department, St Mark’s Hospital and Imperial College, London, United Kingdom
| | | | - Martin Horak
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Dimitrios Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ian Murphy
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland
| | - Jérôme Lambert
- INSERM U1135 Centre de Recherche Epidémiologie et Statistiques, Equipe Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Ryan Ungaro
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frédéric Colombel
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Yves Mary
- INSERM U1135 Centre de Recherche Epidémiologie et Statistiques, Equipe Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments, Université de Paris, Hôpital Saint-Louis, Paris, France
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12
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Mikolasevic I, Rahelic D, Turk-Wensween T, Ruzic A, Domislovic V, Hauser G, Matic T, Radic-Kristo D, Krznaric Z, Radic M, Filipec Kanizaj T, Martinovic M, Jerkic H, Medjimurec M, Targher G. Significant liver fibrosis, as assessed by fibroscan, is independently associated with chronic vascular complications of type 2 diabetes: A multicenter study. Diabetes Res Clin Pract 2021; 177:108884. [PMID: 34082054 DOI: 10.1016/j.diabres.2021.108884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
AIMS The aim of this study was to investigate whether controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as assessed by vibration-controlled transient elastography (VCTE), are associated with chronic vascular complications of diabetes mellitus type 2 (T2DM). METHODS We studied 442 outpatients with established T2DM, and who underwent VCTE and extensive assessment of chronic vascular complications of diabetes. RESULTS A quarter of analyzed patients had a previous history of myocardial infarction and/or ischemic stroke, and about half of them had at least one microvascular complication (chronic kidney disease (CKD), retinopathy or polyneuropathy). The prevalence of liver steatosis (i.e., CAP ≥ 238 dB/m) and significant liver fibrosis (i.e., LSM ≥ 7.0/6.2 kPa) was 84.2% and 46.6%, respectively. Significant liver fibrosis was associated with an increased likelihood of having myocardial infarction (adjusted-odds ratio 6.61, 95%CI 1.66-37.4), peripheral polyneuropathy (adjusted-OR 4.55, 95%CI 1.25-16.6), CKD (adjusted-OR 4.54, 95%CI 1.24-16.6) or retinopathy (adjusted-OR 1.81, 95%CI 1.62-1.97), independently of cardiometabolic risk factors, diabetes-related variables, and other potential confounders. Liver steatosis was not independently associated with any macro-/microvascular diabetic complications. CONCLUSIONS Significant liver fibrosis is strongly associated with the presence of macro-/microvascular complications in patients with T2DM. These results offer a new perspective on the follow-up of people with T2DM.
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Affiliation(s)
- I Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; Faculty of Medicine, Rijeka, Croatia.
| | - D Rahelic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; University of Zagreb Faculty of Medicine, Zagreb, Croatia; University of Osijek Faculty of Medicine, Osijek, Croatia
| | - T Turk-Wensween
- Faculty of Medicine, Rijeka, Croatia; Center for Diabetes, Endocrinology and Cardiometabolism, Thallassotherapia, Opatija, Croatia
| | - A Ruzic
- Faculty of Medicine, Rijeka, Croatia; Clinic for Cardiology, University Hospital Center Rijeka, Rijeka, Croatia
| | - V Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - G Hauser
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Faculty of Medicine, Rijeka, Croatia; Faculty of Health Studies, Rijeka, Croatia
| | - T Matic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - D Radic-Kristo
- University of Zagreb Faculty of Medicine, Zagreb, Croatia; Department of Hematology, University Hospital Merkur, Zagreb, Croatia
| | - Z Krznaric
- University of Zagreb Faculty of Medicine, Zagreb, Croatia; Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - M Radic
- University of Zagreb Faculty of Medicine, Zagreb, Croatia
| | - T Filipec Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; University of Zagreb Faculty of Medicine, Zagreb, Croatia
| | - M Martinovic
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia
| | - H Jerkic
- Department of Cardiology, University Hospital Merkur, Zagreb, Croatia
| | | | - G Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Italy
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13
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Mikolasevic I, Delija B, Mijic A, Stevanovic T, Skenderevic N, Sosa I, Krznaric-Zrnic I, Abram M, Krznaric Z, Domislovic V, Filipec Kanizaj T, Radic-Kristo D, Cubranic A, Grubesic A, Nakov R, Skrobonja I, Stimac D, Hauser G. Small intestinal bacterial overgrowth and non-alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy. Int J Clin Pract 2021; 75:e13947. [PMID: 33406286 DOI: 10.1111/ijcp.13947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/26/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non-alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non-significant or no liver fibrosis. METHODS NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum. RESULTS Patients with non-alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07-37.37), 2.50 (1.16-5.37) and 27.6 (6.41-119), respectively). The most commonly isolated were gram-negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae. CONCLUSION In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well-investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Gastroenterology, UH Merkur, Zagreb, Croatia
| | - Bozena Delija
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Ana Mijic
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | | | | | - Ivan Sosa
- Department of Forensic Medicine and Criminalistics, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | | | - Maja Abram
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Clinical Microbiology, UHC Rijeka, Rijeka, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, Croatia
- Faculty of Medicine, UHC Zagreb, Zagreb, Croatia
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, Croatia
| | - Tajana Filipec Kanizaj
- Department of Gastroenterology, UH Merkur, Zagreb, Croatia
- Faculty of Medicine, UHC Zagreb, Zagreb, Croatia
| | - Delfa Radic-Kristo
- Faculty of Medicine, UHC Zagreb, Zagreb, Croatia
- Department of Hematology, UH Merkur, Zagreb, Croatia
| | - Aleksandar Cubranic
- Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Aron Grubesic
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Hematology, UHC Rijeka, Rijeka, Croatia
| | - Radislav Nakov
- Queen Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ivana Skrobonja
- Department of Clinical Microbiology, UHC Rijeka, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Goran Hauser
- Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Faculty of Health Studies, UHC Rijeka, Rijeka, Croatia
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14
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Mikolasevic I, Domislovic V, Filipec Kanizaj T, Radic-Kristo D, Krznaric Z, Milovanovic T, Juric T, Klapan M, Skenderevic N, Delija B, Stevanovic T, Mijic A, Lukic A, Stimac D. Relationship between coffee consumption, sleep duration and smoking status with elastographic parameters of liver steatosis and fibrosis; controlled attenuation parameter and liver stiffness measurements. Int J Clin Pract 2021; 75:e13770. [PMID: 33070425 DOI: 10.1111/ijcp.13770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
AIM our aim was to explore the association between life habits and the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as the surrogate markers of liver steatosis and fibrosis in a large cohort of non-alcoholic fatty liver disease (NAFLD) patients. METHODS In this prospective, cross-sectional study we had analysed 1998 patients with diagnosed NAFLD. Sleeping duration was categorised in three groups: short (S) (<6 hours), moderate (M) (6-8 hours) and long (L) (>8 hours) sleep duration. Coffee drinking was categorized into no (0), moderate (1-2) and frequent (≥3) consumption (in cups/day). Smoking was categorised as yes versus no. RESULTS Frequent coffee consumers had the lowest prevalence of obesity, hypertension, dyslipidaemia and diabetes. Furthermore, coffee non-consumers had highest values of hepatic enzymes, CAP and LSM. Moderate sleep duration was associated with lower values of CAP and LSM. Coffee consumption was associated with lower CAP in all the multivariate models (CAP unadjusted and model 1, 2 and 3), with largest effect in most frequent coffee consumers (≥3, model 3). Also, most frequent coffee consumers were associated with lower LSM in unadjusted model, model 1 and 2, while this was not the case for model 3 and those who consumed 1-2 cups of coffee per day. Reduced sleeping was confirmed as risk factor for elevated CAP in most of the models (unadjusted and model 1 and 2). Also, negative association of LSM was also confirmed in unadjusted model and model 2. Patients which slept 6-8 hours per day were mostly associated with lower CAP and LSM. Smoking status was not associated with CAP or LSM values. CONCLUSION Coffee consumption has beneficial effect on CAP and LSM and this effect is dose dependent since and independent of a variety of relevant confounders. We have shown that moderate sleep duration has also beneficial effect on CAP and LSM.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Centre Rijeka, Rijeka, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Viktor Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tajana Filipec Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Delfa Radic-Kristo
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia
| | - Zeljko Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tamara Milovanovic
- School of Medicine, University of Belgrade Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Toni Juric
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mia Klapan
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nadija Skenderevic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Bozena Delija
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Ana Mijic
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Andjela Lukic
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, University Hospital Centre Rijeka, Rijeka, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
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15
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Mikolasevic I, Domislovic V, Klapan M, Juric T, Lukic A, Krznaric-Zrnic I, Fuckar-Cupic D, Stimac D, Filipec Kanizaj T, Krznaric Z, Radic-Kristo D, Milic S, Martinovic M, Grubesic A, Grgurevic I. Accuracy of Controlled Attenuation Parameter and Liver Stiffness Measurement in Patients with Non-alcoholic Fatty Liver Disease. Ultrasound Med Biol 2021; 47:428-437. [PMID: 33358052 DOI: 10.1016/j.ultrasmedbio.2020.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/04/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
We evaluated the diagnostic accuracy of the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) measured with either an M or XL probe against liver biopsy (LB) in patients with non-alcoholic fatty liver disease (NAFLD). This study was a cross-sectional prospective study that included 179 NAFLD patients. With a cutoff value for CAP ≥345, we can exclude significant steatosis in 87% (79.4%-92.5%) of our population. With respect to the LSM, the highest accuracy was obtained for F ≥ F3 (area under the receiver operating characteristic curve [AUROC] = 0.98) and F = F4 (AUROC = 0.98). In a multivariable linear regression model, significant predictors influencing LSM were fibrosis stage (β = 2.6, p < 0.001) as a positive predictor and lobular inflammation (β = -0.68, p = 0.04) as a negative predictor, without significant influence after adjustment for CAP and probe type. We found that CAP is a satisfactory method for excluding advanced steatosis, while LSM is a good non-invasive marker for the exclusion of fibrosis.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; Faculty of medicine, Rijeka, Croatia.
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | | | | | | | - Irena Krznaric-Zrnic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Dora Fuckar-Cupic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; Clinical Department of Pathology and Cytology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Faculty of medicine, Rijeka, Croatia
| | - Tajana Filipec Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; Faculty of Medicine, Zagreb, Croatia; Faculty of Medicine, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia; Faculty of Medicine, Zagreb, Croatia
| | | | - Sandra Milic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Faculty of medicine, Rijeka, Croatia
| | - Marko Martinovic
- Department of Hematology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Aron Grubesic
- Faculty of medicine, Rijeka, Croatia; Department of Hematology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Ivica Grgurevic
- Faculty of Medicine, Zagreb, Croatia; Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia
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16
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Mikolasevic I, Domislovic V, Turk Wensveen T, Delija B, Klapan M, Juric T, Lukic A, Mijic A, Skenderevic N, Puz P, Ostojic A, Krznaric Z, Radic-Kristo D, Filipec Kanizaj T, Stimac D. Screening for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography - a prospective, cross sectional study. Eur J Intern Med 2020; 82:68-75. [PMID: 32839076 DOI: 10.1016/j.ejim.2020.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/22/2020] [Accepted: 08/01/2020] [Indexed: 02/08/2023]
Abstract
AIM To investigate the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) in patients with diabetes mellitus type 2 (T2DM), based on increased controlled attenuation parameter (CAP) and liver stiffness measurements obtained by transient elastography. In addition, we aimed to identify parameters that correlate with increased elastographic parameters of steatosis and fibrosis to provide a better indication when a patient with T2DM should be screened for NAFLD. METHODS We conducted prospective, cross-sectional study of 679 consecutive adult patients with diagnosed T2DM mean age 65.2±11.6. NAFLD was defined by transient elastography. In 105 patients a percutaneous liver biopsy (LB) was done. RESULTS The prevalence of NAFLD based on transient elastography was 83.6%. Independent factors associated with increased CAP were higher body mass index, longer T2DM duration, higher serum triglyceride, lower levels of vitamin D, higher C-reactive protein, and higher HOMA-IR. The prevalence of moderate liver fibrosis was 26.9% and advanced liver fibrosis 12.6%. Independent factors associated with moderated fibrosis based on elastography were higher body mass index and higher levels of alanine aminotransferase (ALT), while independent factors associated with advanced fibrosis were female gender, higher body mass index, higher levels of ALT, gama-glutamil transferase and C-reactive protein. Sixty-four (60.9%) of 105 patients with LB had NAFLD activity score ≥5. Regarding the presence and stages of fibrosis based on LB, moderate fibrosis was found in 29.5% of patients, while 29.5% had advanced fibrosis and 6.7% cirrhosis. CONCLUSION This study supports more aggressive screening for NAFLD and fibrosis in patients with T2DM.
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Affiliation(s)
- I Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, Rijeka, Croatia.
| | - V Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - T Turk Wensveen
- School of Medicine, Rijeka, Croatia; Department of Endocrinology, University Hospital Center Rijeka, Rijeka, Croatia
| | - B Delija
- School of Medicine, Rijeka, Croatia
| | - M Klapan
- School of Medicine, Rijeka, Croatia
| | - T Juric
- School of Medicine, Rijeka, Croatia
| | - A Lukic
- School of Medicine, Rijeka, Croatia
| | - A Mijic
- School of Medicine, Rijeka, Croatia
| | - N Skenderevic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - P Puz
- Internal Medicine, General Hospital Koprivnica, Koprivnica, Croatia
| | - A Ostojic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Z Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, Zagreb, Croatia
| | - D Radic-Kristo
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, Osijek, Croatia
| | - T Filipec Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, Zagreb, Croatia
| | - D Stimac
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; School of Medicine, Rijeka, Croatia
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17
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Lukenda Zanko V, Domislovic V, Trkulja V, Krznaric-Zrnic I, Turk-Wensveen T, Krznaric Z, Filipec Kanizaj T, Radic-Kristo D, Bilic-Zulle L, Orlic L, Dinjar-Kujundzic P, Poropat G, Stimac D, Hauser G, Mikolasevic I. Vitamin D for treatment of non-alcoholic fatty liver disease detected by transient elastography: A randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2020; 22:2097-2106. [PMID: 32613718 DOI: 10.1111/dom.14129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/20/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the effects of vitamin D on transient elastography (TE, FibroScan) indices of liver steatosis (controlled attenuation parameter [CAP]) and fibrosis (liver stiffness measurement [LSM]) in adults with non-alcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS In this randomized (2:1), double-blind, single-centre, 12-month trial, patients with NAFLD were treated with vitamin D (1000 IU/day) (n = 201) or a matching placebo (n = 110). Two co-primary outcomes were changes in CAP and LSM after 360 days of treatment versus baseline. Two main secondary outcomes were CAP/LSM changes after 180 days of treatment. RESULTS Both CAP and LSM gradually decreased in vitamin D-treated patients and slightly increased in the placebo arm. Vitamin D was superior to placebo for both primary outcomes (mean differences in CAP and LSM changes (-49.5 dB/m [95% CI -59.5 to -39.4] and -0.72 kPa [95% CI -1.43 to 0.00], respectively) and both secondary outcomes (-22.1 dB/m [-32.1 to -12.1] and -0.89 kPa [-1.61 to -0.17], respectively). Of a number of exploratory outcomes (change at 12 months vs. baseline), vitamin D reduced serum uric acid (-17.9 μmol/L [-30.6 to -5.2]), gamma-glutamyltransferase (-8.9 IU/L [-15.5 to -2.3)] and fasting serum insulin levels (-5.1 pmol/L [-9.3 to -0.8]) as well as the homeostatic model assessment of insulin resistance index (-1.6 [-3.1 to -0.2]) (false discovery rate [5%]-adjusted P-values between .0572 and .0952). CONCLUSION Low-medium dose supplementation of vitamin D (1000 IU/day) over 12 months reduces TE indices of liver steatosis (CAP) and fibrosis (LSM) in NAFLD patients.
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Affiliation(s)
- Vesna Lukenda Zanko
- Department of Internal Medicine, General Hospital "Josip Benčević", Slavonski Brod, Croatia
| | - Viktor Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, School of Medicine Zagreb, Zagreb, Croatia
| | - Irena Krznaric-Zrnic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Tamara Turk-Wensveen
- Department of Endocrinology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - Zeljko Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, Zagreb, Croatia
| | - Tajana Filipec Kanizaj
- School of Medicine, Zagreb, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Delfa Radic-Kristo
- School of Medicine, Zagreb, Croatia
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, Osijek, Croatia
| | - Lidija Bilic-Zulle
- Clinical Institute for Laboratory Diagnostics, Clinical Hospital Centre, Rijeka and Department of Medical Informatics, Rijeka University School of Medicine, Rijeka, Croatia
| | - Lidija Orlic
- School of Medicine, Rijeka, Croatia
- Department of Nephrology, University Hospital Center Rijeka, Rijeka, Croatia
| | | | - Goran Poropat
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - Goran Hauser
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
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18
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Burisch J, Bergemalm D, Halfvarson J, Domislovic V, Krznaric Z, Goldis A, Dahlerup JF, Oksanen P, Collin P, de Castro L, Hernandez V, Turcan S, Belousova E, D'Incà R, Sartini A, Valpiani D, Giannotta M, Misra R, Arebi N, Duricova D, Bortlik M, Gatt K, Ellul P, Pedersen N, Kjeldsen J, Andersen KW, Andersen V, Katsanos KH, Christodoulou DK, Sebastian S, Barros L, Magro F, Midjord JM, Nielsen KR, Salupere R, Kievit HA, Kiudelis G, Kupčinskas J, Fumery M, Gower-Rousseau C, Kaimakliotis IP, Schwartz D, Odes S, Lakatos L, Lakatos PL, Langholz E, Munkholm P. The use of 5-aminosalicylate for patients with Crohn's disease in a prospective European inception cohort with 5 years follow-up - an Epi-IBD study. United European Gastroenterol J 2020; 8:949-960. [PMID: 32715989 DOI: 10.1177/2050640620945949] [Citation(s) in RCA: 15] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The lack of scientific evidence regarding the effectiveness of 5-aminosalicylate in patients with Crohn's disease is in sharp contrast to its widespread use in clinical practice. AIMS The aim of the study was to investigate the use of 5-aminosalicylate in patients with Crohn's disease as well as the disease course of a subgroup of patients who were treated with 5-aminosalicylate as maintenance monotherapy during the first year of disease. METHODS In a European community-based inception cohort, 488 patients with Crohn's disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists. RESULTS Overall, 292 (60%) patients with Crohn's disease received 5-aminosalicylate period during follow-up for a median duration of 28 months (interquartile range 6-60). Of these, 78 (16%) patients received 5-aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5-aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5-aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)). CONCLUSION In this European community-based inception cohort of unselected Crohn's disease patients, 5-aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow-up. Therefore, despite the controversy regarding the efficacy of 5-aminosalicylate in Crohn's disease, its use seems to result in a satisfying disease course for both patients and physicians.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Daniel Bergemalm
- Department of Gastroenterology, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Örebro University, Örebro, Sweden
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, 162072University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, 162072University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Collin
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luisa de Castro
- Digestive Diseases Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain.,Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Vicent Hernandez
- Digestive Diseases Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain.,Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Italy
| | - Alessandro Sartini
- UO Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Daniela Valpiani
- UO Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Martina Giannotta
- Department of Gastroenterology, Azienda USL Toscana Centro, Florence, Italy
| | - Ravi Misra
- IBD Department, Imperial College London, London, UK
| | - Naila Arebi
- IBD Department, Imperial College London, London, UK
| | - Dana Duricova
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, Charles University in Prague, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, Charles University in Prague, Prague, Czech Republic
| | - Kelly Gatt
- Division of Gastroenterology, 223089Mater Dei Hospital, Msida, Malta
| | - Pierre Ellul
- Division of Gastroenterology, 223089Mater Dei Hospital, Msida, Malta
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | - Karina W Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Vibeke Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | | | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK.,Hull York Medical School, Hull, UK
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.,Department of Biomedicine, Porto University, Porto, Portugal
| | - Jóngerð Mm Midjord
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Kári R Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Riina Salupere
- Division of Gastroenterology, University of Tarty, Tartu, Estonia
| | | | - Gediminas Kiudelis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mathurin Fumery
- Gastroenterology Unit, 26993Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Lille University and Hospital, Lille, France.,Institute for Translational Research in Inflammation (Infinite), Lille University, Lille, France
| | | | - Doron Schwartz
- Department of Gastroenterology and Liver Diseases, 26732Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Internal Medicine, 26732Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Laszlo Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Ebbe Langholz
- Department of Gastroenterology, 53176Herlev Hospital, University of Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
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19
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Kopylov U, Hanzel J, Liefferinckx C, De Marco D, Imperatore N, Plevris N, Baston-Rey I, Harris RJ, Truyens M, Domislovic V, Vavricka S, Biemans V, Myers S, Sebastian S, Ben-Horin S, González Lama Y, Gilletta C, Ariella BGS, Zelinkova Z, Weisshof R, Storan D, Zittan E, Farkas K, Molnar T, Franchimont D, Cremer A, Afif W, Castiglione F, Lees C, Barreiro-de Acosta M, Lobaton T, Doherty G, Krznaric Z, Pierik M, Hoentjen F, Drobne D. Effectiveness of ustekinumab dose escalation in Crohn's disease patients with insufficient response to standard-dose subcutaneous maintenance therapy. Aliment Pharmacol Ther 2020; 52:135-142. [PMID: 32412134 DOI: 10.1111/apt.15784] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/26/2020] [Accepted: 04/19/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ustekinumab is effective in Crohn's disease. However, a substantial proportion of patients will not respond or lose response to ustekinumab. The current evidence to support the effectiveness of dose-optimisation for ustekinumab nonresponse is limited. AIM To assess the effectiveness of dose escalation of ustekinumab. METHODS This was a multicentre retrospective cohort study. We included active Crohn's disease patients who received a standard-dose intravenous induction and at least one subcutaneous ustekinumab 90 mg dose. All enrolled patients received dose escalation by either shortening the interval between the doses to every 4 or 6 weeks, intravenous reinduction or a combination of strategies. The primary outcome of the study was clinical response at week 16 after dose escalation. RESULTS A total of 142 patients (22 centres/14 countries) were included. The patients were dose-escalated after a median treatment duration of 30 weeks. At week 16 from escalation, 73/142 (51.4%) responded to treatment, including 55/142 (38.7%) in clinical remission. Corticosteroid-free remission was achieved in 6/34 (17.6%) patients on corticosteroids at the time of escalation; 118/142 (83%) continued treatment beyond week 16. Follow-up data beyond week 16 were available for 74/118 (62.7%) patients. On the last follow-up, 51/98 (52%) patients with available data responded to treatment, including 41/98 (42%) in clinical remission. CONCLUSIONS Intensification of ustekinumab maintenance dosage was effective in over 50% of the patients. This strategy should be considered in patients who are nonresponsive to every 8 weeks ustekinumab maintenance dosing.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Vince Biemans
- Maastricht, The Netherlands.,Nijmegen, The Netherlands
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20
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Mikolasevic I, Lukenda Zanko V, Jakopcic I, Domislovic V, Mijic A, Stevanovic T, Delija B, Bokun T, Dinjar Kujundzic P, Ostojic A, Filipec Kanizaj T, Grgurevic I, Krznaric Z, Stimac D, Targher G. Prospective evaluation of non-alcoholic fatty liver disease by elastographic methods of liver steatosis and fibrosis; controlled attenuation parameter and liver stiffness measurements. J Diabetes Complications 2020; 34:107512. [PMID: 31882273 DOI: 10.1016/j.jdiacomp.2019.107512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/29/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023]
Abstract
AIMS To examine the temporal changes of both controlled attenuation parameter (CAP) and liver stiffness measurements (LSM), assessed by Fibroscan, in a large sample of patients with non-alcoholic fatty liver disease (NAFLD). METHODS In this prospective, observational study, we consecutively enrolled 507 adult individuals with Fibroscan-defined NAFLD who were followed for a mean period of 21.2 ± 11.7 months. RESULTS During the follow-up period, 84 patients (16.5%) had a progression of CAP of at least 20% with a median time of 39.93 months, while 201 (39.6%) patients had a progression of LSM of at least 20% with median time of 30.46 months. There were significant differences in the proportion of LSM progression across body mass index (BMI) categories, with obese patients having the highest risk of progression over the follow-up (hazard ratio 1.66; 95%CI 1.23-2.25). Multivariable regression analysis showed that BMI and serum creatinine levels were the strongest predictors for CAP progression in the whole population, while HOMA-estimated insulin resistance was an independent predictor of LSM progression over time in the subgroup of obese patients. CONCLUSION This prospective study shows for the first time that the progression risk of both liver steatosis and fibrosis, detected non-invasively by Fibroscan, is relevant and shares essentially the same metabolic risk factors that are associated with NAFLD progression detected by other invasive methods.
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Affiliation(s)
- I Mikolasevic
- Department of gastroenterology, UHC Rijeka, Rijeka, Croatia; School of medicine, Rijeka, Croatia; Department of gastroenterology, UH Merkur, Zagreb, Croatia.
| | - V Lukenda Zanko
- Department of Internal medicine, General hospital "Josip Benčević", Slavonski Brod, Croatia
| | | | - V Domislovic
- Department of gastroenterology and hepatology, UHC Zagreb, Zagreb, Croatia
| | - A Mijic
- School of medicine, Rijeka, Croatia
| | | | - B Delija
- School of medicine, Rijeka, Croatia
| | - T Bokun
- Department of gastroenterology and hepatology, UH Dubrava, Zagreb, Croatia
| | | | - A Ostojic
- Department of gastroenterology, UH Merkur, Zagreb, Croatia
| | - T Filipec Kanizaj
- Department of gastroenterology, UH Merkur, Zagreb, Croatia; School of medicine, Zagreb, Croatia
| | - I Grgurevic
- Department of gastroenterology and hepatology, UH Dubrava, Zagreb, Croatia; School of medicine, Zagreb, Croatia
| | - Z Krznaric
- Department of gastroenterology and hepatology, UHC Zagreb, Zagreb, Croatia; School of medicine, Zagreb, Croatia
| | - D Stimac
- Department of gastroenterology, UHC Rijeka, Rijeka, Croatia; School of medicine, Rijeka, Croatia
| | - G Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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21
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Burisch J, Vardi H, Schwartz D, Friger M, Kiudelis G, Kupčinskas J, Fumery M, Gower-Rousseau C, Lakatos L, Lakatos PL, D'Incà R, Sartini A, Valpiani D, Giannotta M, Arebi N, Duricova D, Bortlik M, Chetcuti Zammit S, Ellul P, Pedersen N, Kjeldsen J, Midjord JMM, Nielsen KR, Winther Andersen K, Andersen V, Katsanos KH, Christodoulou DK, Domislovic V, Krznaric Z, Sebastian S, Oksanen P, Collin P, Barros L, Magro F, Salupere R, Kievit HAL, Goldis A, Kaimakliotis IP, Dahlerup JF, Eriksson C, Halfvarson J, Fernandez A, Hernandez V, Turcan S, Belousova E, Langholz E, Munkholm P, Odes S. Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study. Lancet Gastroenterol Hepatol 2020; 5:454-464. [PMID: 32061322 DOI: 10.1016/s2468-1253(20)30012-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up. METHODS The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery. FINDINGS The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001). INTERPRETATION Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease. FUNDING Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark.
| | - Hillel Vardi
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Liver Diseases, Soroka Medical Centre, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gediminas Kiudelis
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Juozas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University, Lille, France; Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | - Laszlo Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Renata D'Incà
- Department of Surgical, Oncological, and Gastroenterological Sciences, Azienda, University of Padua, Padua, Italy
| | - Alessandro Sartini
- Gastroenterology Unit, Bufalini Hospital Cesena, AUSL della Romagna, Rimini, Italy
| | - Daniela Valpiani
- UO Gastroenterologia ed Endoscopia Digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | | | - Naila Arebi
- Inflammatory Bowel Disease Department, Imperial College London, London, UK
| | - Dana Duricova
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | | | - Kári Rubek Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | | | - Vibeke Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Collin
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal; Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | | | - Adrian Goldis
- Clinic of Gastroenterology, Victor Babeş University of Medicine, Timisoara, Romania
| | | | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Vicent Hernandez
- Department of Gastroenterology, Instituto de Investigación Sanitaria Galicia Sur, Hospital Alvaro Cunqueiro, Xerencia Xestion Integrada de Vigo, Vigo, Spain
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Selwyn Odes
- Department of Internal Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Krznaric Ž, Juretic A, Domislovic V, Barisic A, Kekez D, Vranesic Bender D. Ten years of Croatian national guidelines for use of eicosapentaenoic acid and megestrol acetate in cancer cachexia syndrome – Evaluation of awareness and implementation among Croatian oncologists. Clin Nutr ESPEN 2019; 33:202-206. [DOI: 10.1016/j.clnesp.2019.05.013] [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] [Received: 01/24/2019] [Revised: 04/02/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
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Vranesic Bender D, Polancec P, Ljubas Kelecic D, Karas I, Domislovic V, Krznaric Z. SUN-PO208: Comparison of Predicted Versus Measured Resting Energy Expenditure in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD). Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32840-7] [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: 10/26/2022]
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Brozovic M, Knezevic T, Dobrincic Z, Domislovic V, Dapic K, Jelakovic A, Lugovic N, Mrsic M, Radovcic M, Velkovski Skopic O, Jelakovic B. HIGH PREVALENCE OF SUBJECTS WITH HIGH CARDIOVASCULAR RISK IN COMMUNITY PHARMACIES – NEGATIVE TREND IN 2018. J Hypertens 2019. [DOI: 10.1097/01.hjh.0000573196.75033.2f] [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: 11/25/2022]
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Ljubas Kelecic D, Vranesic Bender D, Desnica L, Vukic T, Bender DV, Karas I, Barisic A, Domislovic V, Peric Z, Durakovic N, Seiwerth RS, Vrhovac R, Pulanic D, Nemet D, Pavletic S, Krznaric Z. Sarcopenia in cgvhd patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1440] [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: 10/28/2022]
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26
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Karanovic S, Vrdoljak A, Ivkovic V, Dika Z, Domislovic V, Dapic K, Gallineo L, Ivandic E, Josipovic J, Vukovic I, Kos J, Laganovic M, Vrkic TZ, Fodor L, Matijevic V, Fucek M, Culig J, Stevanovic R, Jelakovic B. [PP.30.14] SALT CONSUMPTION IN CROATIAN CONTINENTAL RURAL POPULATION. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000492249.42673.0b] [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: 11/25/2022]
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