Food protein induced enterocolitis syndrome in adults

Food protein induced enterocolitis syndrome (FPIES) belongs to a group of IgE-independent food allergies. It is the domain of paediatric patients, but it can also occur in adults. In this disease there is a life-threatening risk resulting from the possibility of a severe course of the disease and the development of hypovolemic shock. The disease was first defined in the mid-1970s. Knowledge about this disease is extremely low, we do not know its exact frequency, and the disease itself usually appears between 2 and 7 months of age. FPIES occurs mainly in formula-fed infants, typically 1-4 weeks after formula introduction, very rarely in breastfed infants, but may also develop in adults.

Eosinophilic gastroenteritis - a manifestation of an allergic disease in the gastrointestinal tract? Part 2. Treatment

Treatment of eosinophilic gastroenteritis (EGE) is mainly empirical and is based on the assessment of symptom severity and the experience of clinicians. Patients with mild disease can be treated symptomatically, while patients with more severe symptoms or malabsorption symptoms require more aggressive therapy. So far, several therapeutic options have been proposed, including the following: dietary treatment, glucocorticosteroids, inhibitors of leukotriene receptors, mast cell stabilizers, immunomodulating drugs, and biological drugs. Unfortunately, there is still a lack of well-designed, prospective. and randomized clinical trials involving large groups of patients with EGE and assessing the effectiveness of individual treatments. More research is needed to compare the efficacy and safety profiles of the various treatments available, and to select the prognostic factors of relapse, which in turn will be extremely important in making decisions about the initial treatment phase and maintenance therapy.

Eosinophilic esophagitis. What diet? How to treat it? The point of view of a gastroenterologist working in a department of allergology

Eosinophilic esophagitis (EoE) belongs to a broad group of allergic gastrointestinal diseases. More narrowly, it is classified as an eosinophilic gastrointestinal disease and is its most common representative. Until recently, this disease was extremely rare, but the last 3 decades have seen a rapid increase in its prevalence to such an extent that in some recent studies it has been named the most common esophageal disease after reflux disease. EoE is an interdisciplinary disorder on the borderline between gastrointestinal and allergologic diseases, requiring cooperation of these two branches of medicine in diagnostics and treatment. Despite the development of medical science it remains a poorly known disease, difficult to diagnose and even more difficult to treat. Recent years have seen the emergence of new studies and guidelines, both American and European, that have radically changed our approach to the diagnosis and treatment of EoE.

Comparison of serum prohepcidin and iron metabolism parameters in obese and non-obese elderly individuals

INTRODUCTION

Current knowledge indicates that there is a close connection between being overweight, obesity and iron metabolism disorders,but the underlying mechanism is unclear. Hepcidin could be a major contributor to poor iron status observed in the obese population.

MATERIAL AND METHODS

The study was performed in 58 obese elderly individuals (F/M 34/24) aged 65-91 (78.92 ± 8.32) years. The controlgroup consisted of 15 non-obese elderly volunteers, age- and sex-matched. Based on the WHO definition, 36 (62%) obese individualswere diagnosed with normo- or microcytic anaemia. The following parameters were determined: prohepcidin, haemoglobin, serum iron,erythropoietin, ferritin and C-reactive protein (CRP).

RESULTS

Prohepcidin concentrations were significantly increased in obese elderly individuals without anaemia compared to obese andanaemic (p < 0.01) as well as non-obese volunteers (p < 0.01). In obese individuals with anaemia there was a decrease in serum iron,concomitant with increased levels of erythropoietin and CRP compared to two other groups. Ferritin concentration was increased inobese people (with and without anaemia) compared to the non-obese group. Serum prohepcidin levels were positively correlated withfat mass percentage in obese individuals without and with anaemia (r = 0.32; p = 0.02).

CONCLUSION

Results of this preliminary study suggest that body fat content does have an impact on prohepcidin concentration, andthereby on iron homeostasis.

The role of hepcidin and haemojuvelin in the pathogenesis of iron disorders in patients with severe malnutrition

INTRODUCTION AND OBJECTIVE

The clinical consequences of malnutrition are multi-directional and result in dysfunctions of the majority of internal organs and systems. The results of recent studies suggest that a significant role is played by malnutrition in pathophysiology of iron homeostasis disorders, but the underlying mechanism is unclear. The study describes the potential role of hepcidin and hemojuvelin in the pathogenesis of disorders of iron metabolism during malnutrition.

STATE OF KNOWLEDGE

The participation of hepcidin in regulating iron homeostasis encompasses inhibiting the absorption of food iron from enterocytes and inhibiting the release of stored iron from the reticuloendothelial system cells. One of the factors that increases the post-translational level is the expression of hepcidin is IL-6. In studies focused on malnutrition it was observed that in persons with protein and energy deficits the level of proinflammatory cytokine, i.e. interleukin-6, in the serum, increased. The involvement of haemojuvelin in the overall iron homeostasis is related with the regulation of expression of the hepcidin coding gene on the transcription level. The highest haemojuvelin expression was observed in humans in skeletal muscles. Observations and analyses conducted in vivo allowed the conclusion that soluble HJV and cell-related haemojuvelin regulate hepcidin expression in response to changes in iron concentration. The research also demonstrated that soluble HJV neutralizes the inductive effect of IL-6 action on hepcidin expression.

SUMMARY

It can be claimed that in persons with protein and/or protein-energetic malnutrition the muscle mass deficit may lead to insufficient production of haemojuvelin and sideropenia.

Serum prohepcidin and other iron metabolism parameters in elderly patients with anemia of chronic disease and with iron deficiency anemia

INTRODUCTION

The diagnosis of iron deficiency anemia (IDA) in the context of the anemia of chronic disease (ACD) in elderly patients is often difficult due to the existence of many disorders. Recent studies have shown that hepcidin measurement (combined with the existing diagnostic methods) may possibly help in the differential diagnosis of IDA and ACD.

OBJECTIVES

The aim of the study was to evaluate the differential diagnostic value of serum prohepcidin in elderly patients with IDA and ACD.

PATIENTS AND METHODS

The study included 65 individuals aged 65 years or more: 26 patients with ACD, 13 patients with IDA, and 26 age-matched controls. Prohepcidin, ferritin, soluble transferrin receptor, erythropoietin, and interleukin 6 (IL-6) were measured using the commercially available enzyme-linked immunosorbent assay kits. Complete blood count, total iron-binding capacity (TIBC), and iron, transferrin, and C-reactive protein (CRP) levels were assayed using the standard laboratory methods.

RESULTS

Prohepcidin concentrations were similar in patients with ACD (196.59 ng/ml) compared with those with IDA (230.16 ng/ml) (P = 0.35). Patients with ACD had significantly lower levels of TIBC compared with those with IDA (P <0.0001). Serum ferritin concentration in patients with ACD was almost 20-fold higher compared with those observed in patients with IDA (P <0.0001). CRP and IL-6 concentrations in patients with ACD were significantly higher compared with those with IDA.

CONCLUSIONS

The results of the study indicate that serum prohepcidin has limited value in the differential diagnosis of IDA and ACD in elderly patients.

Prohepcidin and iron metabolism parameters in the obese elderly patients with anemia

OBJECTIVE

To examine the impact of a body fat content on the concentration of a serum prohepcidin, iron metabolism parameters and inflammation markers in elderly patients with microcytic or normocytic anemia.

DESIGN

Clinical study with biochemical and anthropometric measurements.

SUBJECTS

Fifty two elderly patients (19 male, 33 female) with anemia, 65-91 years of age.

MEASUREMENTS

Prohepcidin, ferritin, soluble transferrin receptor, erythropoietin and interleukin-6 were measured using commercially available ELISA kits. Iron, TIBC, transferrin, C-reactive protein and complete blood count were assayed using standard laboratory methods. Body fat content, fat distribution and protein nutrition state parameters were assessed by means of anthropometry.

RESULTS

Mean serum prohepcidin levels were significantly higher in patients with high body fat content in comparison to patients with normal body fat content (224,85 vs 176,6 ng/ml). Prohepcidin levels of the elderly patients with anemia were positively correlated with biceps, subscapular and suprailiac skinfold thickness or body fat mass percentage. In our study serum prohepcidin levels do not correlate with any iron parameters or inflammation markers.

CONCLUSION

Summing up, the results of this study indicate that increased prohepcidin concentration, observed in obese elderly patients with anemia, may play an important role in iron deficiency development.