V. interná klinika LF UK a FNsP, Bratislava 8 Oddelenie onkologickej genetiky, Národný onkologick... more V. interná klinika LF UK a FNsP, Bratislava 8 Oddelenie onkologickej genetiky, Národný onkologický ústav, Bratislava Súhrn: Peutz-Jeghersov syndróm je vzácne autozomálne dominantne dedičné ochorenie charakterizované hamartomatóznymi polypmi tráviaceho traktu, mukokutánnymi pigmentáciami a zvýšeným rizikom malígneho ochorenia. Diagnostika sa opiera o prítomnosť mukokutánnych pigmentácii, histologické vyšetrenie polypov s nálezom typických hamartómov a o genetickú analýzu. Mutácia tumorsupresorového génu STKYY kódujúci serín-treonín kinázu YY je zatiaľ jedinou známou príčinou Peutz-Jeghersovho syndrómu. Doposiaľ bolo popísaných vyše Y\] typov mutácií tohto génu pravdepodobne zodpovedných za veľkú variabilitu jeho fenotypového prejavu. Liečba ochorenia spočíva v pravidelnom endoskopickom alebo chirurgickom odstraňovaní polypov a v špecifickom onkologickom screeningu v snahe znížiť riziko vzniku závažných komplikácií polypózy a zabrániť rozvoju pokročilých foriem onkologických ochorení.
NEGATIVE PREDICTIVE VALUE OF TRANSABDOMINAL ULTRASOUND FOR SHORT-TERM OUTCOMES OF INFLAMMATORY BO... more NEGATIVE PREDICTIVE VALUE OF TRANSABDOMINAL ULTRASOUND FOR SHORT-TERM OUTCOMES OF INFLAMMATORY BOWEL DISEASE Sturdik Igor, Toth Jozef, Hlavaty Tibor, Koller Tomas, Huorka Martin, Zelinkova Zuzana Background Transabdominal ultrasound is considered a useful tool for the assessment of inflammatory bowel disease (IBD) acitvity but its negative predictive value for gold standards diagnostic methods, such as endoscopy, is limited. Therefore, usefullness of transabdominal ultrasound in monitoring of disease activity has been questioned. However, the diagnostic value of ultrasound has not been tested with regards to short or long-term outcomes of IBD. Aim The aim of our study was to assess the negative predictive value of transabdominal ultrasound in IBD for short –term disease complications. Materials and methods We retrospectively evaluated all IBD patients with clinical suspicion of disease flare who underwent an intestinal ultrasound performed by one sonographist at a single tertiary IB...
Prolactin concentration was proved to be associated with complications of cirrhosis. This relatio... more Prolactin concentration was proved to be associated with complications of cirrhosis. This relationship was investigated on the group of 90 patients predominantly males with alcoholic cirrhosis. Basic clinical and laboratory data were collected at entry as well as complications of cirrhosis already present. Patients were followed for the mean of 434 days and events such as variceal bleeding, hepatorenal syndrome and death were recorded. We found that 16.7% of patients had elevated serum prolactin levels, and had significantly higher Child-Pugh and MELD scores as well as higher ascites and encephalopathy stage. By comparing prolactin concentration quartiles we found complications of cirrhosis such as ascites, higher INR, jaundice and higher Child-Pugh and MELD scores more often with increasing prolactin concentrations. The most prominent was the relationship to hepatic encephalopathy (0 vs 31% between the 1st and 4th quartile, p < 0.05) to which the prolactin levels above 10.5 micr...
Osteoporosis is a known chronic complication of inflammatory bowel diseases (IBD). The aim of our... more Osteoporosis is a known chronic complication of inflammatory bowel diseases (IBD). The aim of our study was to describe the prevalence of reduced bone mineral density (BMD) in IBD patients and to identify crucial risk factors for osteoporosis. The cohort consisted of 76 IBD patients, 40 with Crohn's disease (CD) and 36 with ulcerative colitis (UC). Clinical characteristics of every patient were recorded, i.e. age, sex, duration of the disease, clinical behavior, location of disease according to Montreal classification, surgeries, steroid medication, sIBDQ, and smoking habits. We examined the serum 25-hydroxyl vitamin D3 (25-OHD3) in each patient. The BMD was determined by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral neck. Osteoporosis was documented in 10 IBD patients (13.2 %), while osteopenia in 35 of them (46.1 %). Patients with CD have significantly lower femoral Z score than patients with UC. Femoral Z score was strongly associated with disease dur...
The thiopurine drugs, azathioprine (AZA) and 6-mercaptopurine, are established in the treatment o... more The thiopurine drugs, azathioprine (AZA) and 6-mercaptopurine, are established in the treatment of inflammatory bowel diseases (IBD). Polymorphisms in thiopurine S-methyltransferase (TPMT) gene have been associated with adverse drug reactions (ADRs) to AZA. The aim of this study was to evaluate TPMT polymorphisms and AZA-related toxicity in a Slovak cohort of 220 IBD patients treated with AZA. In every patient, the dose and duration of AZA therapy, concomitant 5-aminosalicylate (5-ASA) medication, frequency, type, time to onset, dose of ADR and concomitant 5-ASA at the onset of ADR were recorded. Each patient was also genotyped for the presence of variant TPMT alleles (*2,*3A,*3B,*3C). Frequency, type and circumstances of ADRs were compared according to TPMT status. Of the 220 patients, 205 (93.2 %) were wild-type (TPMT*1/*1), one (0.5%) carried a TPMT*1/*3C allele, 13 (5.9 %) carried TPMT *1/*3A allele and one was homozygous for TMPT *3A allele. No TPMT *2 mutation was found. The i...
Thiopurine S-methyltransferase (TPMT) plays an important role in the metabolism of thiopurines. I... more Thiopurine S-methyltransferase (TPMT) plays an important role in the metabolism of thiopurines. It has been suggested that TPMT genetic polymorphisms lead to dose-related hematopoetic toxicity. Since there are major ethnic differences in the prevalence of particular TPMT variants, it is important for each country to study their own prevalence in order to estimate the role of TPMT variants-related thiopurines toxicity in the particular inflammatory bowel disease (IBD) population. The aim of this study was to determine the frequency of the four most common allelic variants of TPMT gene in the population of Slovak IBD patients. TPMT genetic polymorphisms (TPMT*2, TPMT*3A, TPMT*3B, TPMT*3C) were amplified using PCR and consequently genotyped on genetic analyzer. The allele frequencies of particular allelic variants were calculated and compared with other Caucasian populations reported so far. Three hundred and thirty IBD patients were included; 196/132/2 Crohn´s disease/ulcerative colit...
Non-alcoholic fatty liver disease is one of the most common liver diseases. It's prevalence a... more Non-alcoholic fatty liver disease is one of the most common liver diseases. It's prevalence among patients with metabolic risk factors (obesity, type 2 diabetes, hypertension, lipid disorders) without previously recognized liver disease is not completely known. Aims of our study were to determine the prevalence of liver lesions (elevated alanin aminotransferase (ALT), gamma glutamyl transpeptidase (GGT) above normal range and ultrasound signs of liver steatosis) among the study group of patients with at least one metabolic risk factor, to compare it with the control group with no risk factor, to investigate it's association with the number of metabolic risk factors and to identify it's closest independent predictors. Patients with other known liver diseases were excluded. Among 482 patients 429 were in the study group and 53 in the control group. In the study group the prevalence ofALT, GGT elevation and signs ofsteatosis was 12.1, 29.9, 38.3%, comparing to 5.7, 11.9 and...
To investigate the effect of vitamin D (VD) concentrations and VD supplementation on health relat... more To investigate the effect of vitamin D (VD) concentrations and VD supplementation on health related quality of life in inflammatory bowel disease (IBD) patients. A cohort of 220 IBD patients including 141 Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (CD) and 79 ulcerative colitis (UC) patients was followed-up at a tertiary IBD center. A subgroup of the cohort (n = 26) took VD supplements for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3 mo. Health related quality of life was assessed using the short IBD questionnaire (sIBDQ). VD serum concentration and sIBDQ score were assessed between August and October 2012 (summer/autumn period) and between February and April 2013 (winter/spring period). The mean VD serum concentration and its correlation with disease activity of CD were determined for each season separately. In a subgroup of patients, the effects of VD supplementation on winter VD serum concentration, change in VD serum concentration from summer to winter, and winter sIBDQ score were analyzed. During the summer/autumn and the winter/spring period, 28% and 42% of IBD patients were VD-deficient (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 20 ng/mL), respectively. In the winter/spring period, there was a significant correlation between sIBDQ score and VD serum concentration in UC patients (r = 0.35, P = 0.02), with a trend towards significance in CD patients (r = 0.17, P = 0.06). In the winter/spring period, VD-insufficient patients (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 30 ng/mL) had a significantly lower mean sIBDQ score than VD-sufficient patients; this was true of both UC (48.3 ± 2.3 vs 56.7 ± 3.4, P = 0.04) and CD (55.7 ± 1.25 vs 60.8 ± 2.14, P = 0.04) patients. In all analyzed scenarios (UC/CD, the summer/autumn period and the winter/spring period), health related quality of life was the highest in patients with VD serum concentrations of 50-59 ng/mL. Supplementation with a median of 800 IU/d VD day did not influence VD serum concentration or the sIBDQ score. VD serum concentration correlated with health related quality of life in UC and CD patients during the winter/spring period.
Background: The aetiology of inflammatory bowel disease (IBD) is not known but is likely to invol... more Background: The aetiology of inflammatory bowel disease (IBD) is not known but is likely to involve a combination of genetic predisposition and environmental risk factors. Smoking has been associated consistently with a higher risk of Crohn's disease (CD), while appendectomy and smoking appear to diminish the risk of ulcerative colitis (UC). The roles of other environmental factors are unclear. The aim of the present study was to evaluate the association of CD and UC with several environmental risk factors. Methods: This case-control study included 338 patients (190 CD, 148 UC) and 355 controls. All subjects completed a detailed questionnaire regarding breastfeeding duration, history of helminthic infections, allergic diseases, appendectomy, household size, housing type, contact with specific domestic animals, physical activity, and smoking. Associations between risk factors and CD and UC were investigated by univariate and multivariate analysis. Results: On multivariate analysis, CD associated with smoking at diagnosis (odds ratio, OR, 3.7, 95% CI 2.2-6.2; p < 0.001), being breastfed for <6 months (OR 2.7, 95% CI 1.7-4.4; p < 0.001), and less than two childhood sporting activities weekly (OR 2.7, 95% CI 1.5-5.0; p < 0.001) and inversely associated with frequent contact with cats in childhood (OR 0.6, 95% CI 0.4-0.9; p < 0.03). UC associated with less than two sporting weekly activities in childhood (OR 2.0, 95% CI 1.1-3.5, p ¼ 0.02), fewer household members in childhood (OR 0.8, 95% CI 0.7-0.98, p ¼ 0.03), and being breastfed for <6 months (OR 1.7, 95% CI 1.02-2.8, p ¼ 0.04). A composite environmental risk index for CD revealed that 47 and 14% of the controls and patients with CD had no risk factors, respectively, and that 14 and 38% of the controls and patients with CD had at least two risk factors, respectively. Conclusion: CD and UC associated with infrequent childhood sports activities and short breastfeeding. Furthermore, CD associated with smoking and infrequent contact with animals in childhood. UC associated with a smaller family size in childhood.
There is a high prevalence of low bone mineral density (BMD) among patients with inflammatory bow... more There is a high prevalence of low bone mineral density (BMD) among patients with inflammatory bowel disease (IBD) although there is a lack of clinical data on the impact of IBD specific medications and recommended vitamin D (VD) and calcium (Ca) supplements on it. The cohort consisted of 150 IBD patients. The average change in BMD at the lumbar spine per year (∆BMDL/year) was calculated and the impact of clinical characteristics, medications and VD and Ca supplements was analysed. The prevalence of osteopenia was 69/150 (46%) and osteoporosis was identified in 15/150 (10%) patients at baseline. The presence of osteoporosis was associated with the disease duration OR=1.07 per year of disease duration (95% CI=1.01-1.14), p=0.03. The average ∆BMDL/year was 0.010 g/cm(2)/year. Among patients with no IS the ∆BMDL/year was -0.001±0.010 g/cm(2)/year, with AZA -0.001±0.013 g/cm(2)/year, with anti-TNFα 0.003±0.006 g/cm(2)/year and with COMBO 0.027±0.004 g/cm(2)/year; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 COMBO vs any other subgroup. ∆BMDL/year among patients treated with CS was -0.031±0.012 g/cm(2)/year versus CS free patients 0.013±0.004 g/cm(2)/year; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001. There was no effect of VD/Ca supplementation on BMDL. The prevalence of low BMD was 55%. Duration of disease was the only independent predictor of low BMD. The BMDL was reduced by high cumulative dose of CS and improved by combined anti-TNFα/AZA therapy. The supplementation with recommended doses of VD and Ca had no effect on BMDL.
Cholelithiasis and nonalcoholic fatty liver disease (NAFLD) share the same risk factors. The aim ... more Cholelithiasis and nonalcoholic fatty liver disease (NAFLD) share the same risk factors. The aim of our study was to explore the relationship between these two conditions and to identify independent predictors of both diseases in a cohort of patients with metabolic risk factors. Consecutive patients with metabolic risk factors referred to the outpatient clinic during a one-year period were included. Cholelithiasis was defined by the presence of gallstones on abdominal ultrasound examination at inclusion or previously performed cholecystectomy. NAFLD was defined by the presence of at least one surrogate marker such as elevated alanine aminotransferase and/or gamma-glutamyl transpeptidase and/or ultrasound signs of fatty liver. Other common liver diseases were thoroughly excluded. The prevalence of cholelithiasis among patients with and without NAFLD was determined and clinical and laboratory parameters were identified as predictors of NAFLD by multivariate logistic regression. In total, 482 consecutive patients were included: mean age 61 years; 61% were women; 52% of patients had more than 2 metabolic risk factors (obesity, type 2 diabetes, hypertension, hypertriglyceridemia, or low HDL cholesterol). NAFLD and cholelithiasis were present in 41% and 34% of all patients, respectively. Significantly higher prevalence of cholelithiasis was found among patients with NAFLD compared with patients without NAFLD (47% vs. 26%, respectively; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In multivariate logistic regression model, type 2 diabetes (odds ratio (OR) = 1.99), BMI above 25 kg/m(2) (OR = 1.78), and cholelithiasis (OR = 1.77) were identified as independent predictors of NAFLD. Fifty six percent of patients with cholelithiasis had NAFLD compared with 33% of patients without cholelithiasis (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Multivariate logistic regression identified age above 50 years (OR = 3.46), NAFLD (OR = 1.92), triglycerides above 1.7 mmol/l (OR = 1.91), BMI above 25 kg/m(2) (OR = 1.84), and total cholesterol concentration (OR = 0.711) as independent predictors of cholelithiasis. In conclusion, patients with metabolic risk factors and cholelithiasis suffer significantly more often from NAFLD compared with the reference group. Cholelithiasis represents an independent risk factor of NAFLD in addition to metabolic risk factors and could be regarded as an additional risk factor of liver damage in patients with NAFLD. Furthermore, NAFLD is an independent risk factor for cholelithiasis and might represent a pathogenetic link between the metabolic syndrome and cholelithiasis.
POSTERS CI 1. 012-1.61, p = 0.039). Multivariate regression analysis showed that CAC score was as... more POSTERS CI 1. 012-1.61, p = 0.039). Multivariate regression analysis showed that CAC score was associated with male sex (OR 2.73), Age (<50 yr reference; 50-59 yr OR 3.75; 60-69 yr OR 8.42; over 70 yr OR 21.38), diabetes (OR 1.39), hypertension (OR 1.79), current smoker (OR 1.42) and presence of NAFLD (OR 1.36). Conclusions: Patients with NAFLD are at high risk of coronary atherosclerosis regardless of individuals traits of metabolic syndrome and classical cardiovascular risk factors. Detection of NAFLD should alert to the existence of an increased cardiovascular risk.
European Journal of Gastroenterology & Hepatology, 2014
We report here an unusual case of delayed hypersensitivity reaction in a young woman with ulcerat... more We report here an unusual case of delayed hypersensitivity reaction in a young woman with ulcerative colitis after the first administration of infliximab (IFX). The patient developed severe serum-sickness-like reaction, and her anti-IFX antibody titer increased rapidly after a single infusion of IFX. The possible reason for the delayed hypersensitivity reaction to a single IFX exposure might be the presensitization of the patient by murine antigens as she had been keeping mice and hamsters as pets for several years.
European Journal of Gastroenterology & Hepatology, 2011
Background Patients with ulcerative colitis and Crohn's colitis have increased risk of colorectal... more Background Patients with ulcerative colitis and Crohn's colitis have increased risk of colorectal cancer. Current screening endoscopy protocols based on white light endoscopy (WLE) and random biopsies are laborious and of uncertain sensitivity. Novel endoscopic techniques include chromoendoscopy (CE) and confocal laser endomicroscopy (CLE).
V. interná klinika LF UK a FNsP, Bratislava 8 Oddelenie onkologickej genetiky, Národný onkologick... more V. interná klinika LF UK a FNsP, Bratislava 8 Oddelenie onkologickej genetiky, Národný onkologický ústav, Bratislava Súhrn: Peutz-Jeghersov syndróm je vzácne autozomálne dominantne dedičné ochorenie charakterizované hamartomatóznymi polypmi tráviaceho traktu, mukokutánnymi pigmentáciami a zvýšeným rizikom malígneho ochorenia. Diagnostika sa opiera o prítomnosť mukokutánnych pigmentácii, histologické vyšetrenie polypov s nálezom typických hamartómov a o genetickú analýzu. Mutácia tumorsupresorového génu STKYY kódujúci serín-treonín kinázu YY je zatiaľ jedinou známou príčinou Peutz-Jeghersovho syndrómu. Doposiaľ bolo popísaných vyše Y\] typov mutácií tohto génu pravdepodobne zodpovedných za veľkú variabilitu jeho fenotypového prejavu. Liečba ochorenia spočíva v pravidelnom endoskopickom alebo chirurgickom odstraňovaní polypov a v špecifickom onkologickom screeningu v snahe znížiť riziko vzniku závažných komplikácií polypózy a zabrániť rozvoju pokročilých foriem onkologických ochorení.
NEGATIVE PREDICTIVE VALUE OF TRANSABDOMINAL ULTRASOUND FOR SHORT-TERM OUTCOMES OF INFLAMMATORY BO... more NEGATIVE PREDICTIVE VALUE OF TRANSABDOMINAL ULTRASOUND FOR SHORT-TERM OUTCOMES OF INFLAMMATORY BOWEL DISEASE Sturdik Igor, Toth Jozef, Hlavaty Tibor, Koller Tomas, Huorka Martin, Zelinkova Zuzana Background Transabdominal ultrasound is considered a useful tool for the assessment of inflammatory bowel disease (IBD) acitvity but its negative predictive value for gold standards diagnostic methods, such as endoscopy, is limited. Therefore, usefullness of transabdominal ultrasound in monitoring of disease activity has been questioned. However, the diagnostic value of ultrasound has not been tested with regards to short or long-term outcomes of IBD. Aim The aim of our study was to assess the negative predictive value of transabdominal ultrasound in IBD for short –term disease complications. Materials and methods We retrospectively evaluated all IBD patients with clinical suspicion of disease flare who underwent an intestinal ultrasound performed by one sonographist at a single tertiary IB...
Prolactin concentration was proved to be associated with complications of cirrhosis. This relatio... more Prolactin concentration was proved to be associated with complications of cirrhosis. This relationship was investigated on the group of 90 patients predominantly males with alcoholic cirrhosis. Basic clinical and laboratory data were collected at entry as well as complications of cirrhosis already present. Patients were followed for the mean of 434 days and events such as variceal bleeding, hepatorenal syndrome and death were recorded. We found that 16.7% of patients had elevated serum prolactin levels, and had significantly higher Child-Pugh and MELD scores as well as higher ascites and encephalopathy stage. By comparing prolactin concentration quartiles we found complications of cirrhosis such as ascites, higher INR, jaundice and higher Child-Pugh and MELD scores more often with increasing prolactin concentrations. The most prominent was the relationship to hepatic encephalopathy (0 vs 31% between the 1st and 4th quartile, p < 0.05) to which the prolactin levels above 10.5 micr...
Osteoporosis is a known chronic complication of inflammatory bowel diseases (IBD). The aim of our... more Osteoporosis is a known chronic complication of inflammatory bowel diseases (IBD). The aim of our study was to describe the prevalence of reduced bone mineral density (BMD) in IBD patients and to identify crucial risk factors for osteoporosis. The cohort consisted of 76 IBD patients, 40 with Crohn's disease (CD) and 36 with ulcerative colitis (UC). Clinical characteristics of every patient were recorded, i.e. age, sex, duration of the disease, clinical behavior, location of disease according to Montreal classification, surgeries, steroid medication, sIBDQ, and smoking habits. We examined the serum 25-hydroxyl vitamin D3 (25-OHD3) in each patient. The BMD was determined by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral neck. Osteoporosis was documented in 10 IBD patients (13.2 %), while osteopenia in 35 of them (46.1 %). Patients with CD have significantly lower femoral Z score than patients with UC. Femoral Z score was strongly associated with disease dur...
The thiopurine drugs, azathioprine (AZA) and 6-mercaptopurine, are established in the treatment o... more The thiopurine drugs, azathioprine (AZA) and 6-mercaptopurine, are established in the treatment of inflammatory bowel diseases (IBD). Polymorphisms in thiopurine S-methyltransferase (TPMT) gene have been associated with adverse drug reactions (ADRs) to AZA. The aim of this study was to evaluate TPMT polymorphisms and AZA-related toxicity in a Slovak cohort of 220 IBD patients treated with AZA. In every patient, the dose and duration of AZA therapy, concomitant 5-aminosalicylate (5-ASA) medication, frequency, type, time to onset, dose of ADR and concomitant 5-ASA at the onset of ADR were recorded. Each patient was also genotyped for the presence of variant TPMT alleles (*2,*3A,*3B,*3C). Frequency, type and circumstances of ADRs were compared according to TPMT status. Of the 220 patients, 205 (93.2 %) were wild-type (TPMT*1/*1), one (0.5%) carried a TPMT*1/*3C allele, 13 (5.9 %) carried TPMT *1/*3A allele and one was homozygous for TMPT *3A allele. No TPMT *2 mutation was found. The i...
Thiopurine S-methyltransferase (TPMT) plays an important role in the metabolism of thiopurines. I... more Thiopurine S-methyltransferase (TPMT) plays an important role in the metabolism of thiopurines. It has been suggested that TPMT genetic polymorphisms lead to dose-related hematopoetic toxicity. Since there are major ethnic differences in the prevalence of particular TPMT variants, it is important for each country to study their own prevalence in order to estimate the role of TPMT variants-related thiopurines toxicity in the particular inflammatory bowel disease (IBD) population. The aim of this study was to determine the frequency of the four most common allelic variants of TPMT gene in the population of Slovak IBD patients. TPMT genetic polymorphisms (TPMT*2, TPMT*3A, TPMT*3B, TPMT*3C) were amplified using PCR and consequently genotyped on genetic analyzer. The allele frequencies of particular allelic variants were calculated and compared with other Caucasian populations reported so far. Three hundred and thirty IBD patients were included; 196/132/2 Crohn´s disease/ulcerative colit...
Non-alcoholic fatty liver disease is one of the most common liver diseases. It's prevalence a... more Non-alcoholic fatty liver disease is one of the most common liver diseases. It's prevalence among patients with metabolic risk factors (obesity, type 2 diabetes, hypertension, lipid disorders) without previously recognized liver disease is not completely known. Aims of our study were to determine the prevalence of liver lesions (elevated alanin aminotransferase (ALT), gamma glutamyl transpeptidase (GGT) above normal range and ultrasound signs of liver steatosis) among the study group of patients with at least one metabolic risk factor, to compare it with the control group with no risk factor, to investigate it's association with the number of metabolic risk factors and to identify it's closest independent predictors. Patients with other known liver diseases were excluded. Among 482 patients 429 were in the study group and 53 in the control group. In the study group the prevalence ofALT, GGT elevation and signs ofsteatosis was 12.1, 29.9, 38.3%, comparing to 5.7, 11.9 and...
To investigate the effect of vitamin D (VD) concentrations and VD supplementation on health relat... more To investigate the effect of vitamin D (VD) concentrations and VD supplementation on health related quality of life in inflammatory bowel disease (IBD) patients. A cohort of 220 IBD patients including 141 Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (CD) and 79 ulcerative colitis (UC) patients was followed-up at a tertiary IBD center. A subgroup of the cohort (n = 26) took VD supplements for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3 mo. Health related quality of life was assessed using the short IBD questionnaire (sIBDQ). VD serum concentration and sIBDQ score were assessed between August and October 2012 (summer/autumn period) and between February and April 2013 (winter/spring period). The mean VD serum concentration and its correlation with disease activity of CD were determined for each season separately. In a subgroup of patients, the effects of VD supplementation on winter VD serum concentration, change in VD serum concentration from summer to winter, and winter sIBDQ score were analyzed. During the summer/autumn and the winter/spring period, 28% and 42% of IBD patients were VD-deficient (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 20 ng/mL), respectively. In the winter/spring period, there was a significant correlation between sIBDQ score and VD serum concentration in UC patients (r = 0.35, P = 0.02), with a trend towards significance in CD patients (r = 0.17, P = 0.06). In the winter/spring period, VD-insufficient patients (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 30 ng/mL) had a significantly lower mean sIBDQ score than VD-sufficient patients; this was true of both UC (48.3 ± 2.3 vs 56.7 ± 3.4, P = 0.04) and CD (55.7 ± 1.25 vs 60.8 ± 2.14, P = 0.04) patients. In all analyzed scenarios (UC/CD, the summer/autumn period and the winter/spring period), health related quality of life was the highest in patients with VD serum concentrations of 50-59 ng/mL. Supplementation with a median of 800 IU/d VD day did not influence VD serum concentration or the sIBDQ score. VD serum concentration correlated with health related quality of life in UC and CD patients during the winter/spring period.
Background: The aetiology of inflammatory bowel disease (IBD) is not known but is likely to invol... more Background: The aetiology of inflammatory bowel disease (IBD) is not known but is likely to involve a combination of genetic predisposition and environmental risk factors. Smoking has been associated consistently with a higher risk of Crohn's disease (CD), while appendectomy and smoking appear to diminish the risk of ulcerative colitis (UC). The roles of other environmental factors are unclear. The aim of the present study was to evaluate the association of CD and UC with several environmental risk factors. Methods: This case-control study included 338 patients (190 CD, 148 UC) and 355 controls. All subjects completed a detailed questionnaire regarding breastfeeding duration, history of helminthic infections, allergic diseases, appendectomy, household size, housing type, contact with specific domestic animals, physical activity, and smoking. Associations between risk factors and CD and UC were investigated by univariate and multivariate analysis. Results: On multivariate analysis, CD associated with smoking at diagnosis (odds ratio, OR, 3.7, 95% CI 2.2-6.2; p < 0.001), being breastfed for <6 months (OR 2.7, 95% CI 1.7-4.4; p < 0.001), and less than two childhood sporting activities weekly (OR 2.7, 95% CI 1.5-5.0; p < 0.001) and inversely associated with frequent contact with cats in childhood (OR 0.6, 95% CI 0.4-0.9; p < 0.03). UC associated with less than two sporting weekly activities in childhood (OR 2.0, 95% CI 1.1-3.5, p ¼ 0.02), fewer household members in childhood (OR 0.8, 95% CI 0.7-0.98, p ¼ 0.03), and being breastfed for <6 months (OR 1.7, 95% CI 1.02-2.8, p ¼ 0.04). A composite environmental risk index for CD revealed that 47 and 14% of the controls and patients with CD had no risk factors, respectively, and that 14 and 38% of the controls and patients with CD had at least two risk factors, respectively. Conclusion: CD and UC associated with infrequent childhood sports activities and short breastfeeding. Furthermore, CD associated with smoking and infrequent contact with animals in childhood. UC associated with a smaller family size in childhood.
There is a high prevalence of low bone mineral density (BMD) among patients with inflammatory bow... more There is a high prevalence of low bone mineral density (BMD) among patients with inflammatory bowel disease (IBD) although there is a lack of clinical data on the impact of IBD specific medications and recommended vitamin D (VD) and calcium (Ca) supplements on it. The cohort consisted of 150 IBD patients. The average change in BMD at the lumbar spine per year (∆BMDL/year) was calculated and the impact of clinical characteristics, medications and VD and Ca supplements was analysed. The prevalence of osteopenia was 69/150 (46%) and osteoporosis was identified in 15/150 (10%) patients at baseline. The presence of osteoporosis was associated with the disease duration OR=1.07 per year of disease duration (95% CI=1.01-1.14), p=0.03. The average ∆BMDL/year was 0.010 g/cm(2)/year. Among patients with no IS the ∆BMDL/year was -0.001±0.010 g/cm(2)/year, with AZA -0.001±0.013 g/cm(2)/year, with anti-TNFα 0.003±0.006 g/cm(2)/year and with COMBO 0.027±0.004 g/cm(2)/year; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 COMBO vs any other subgroup. ∆BMDL/year among patients treated with CS was -0.031±0.012 g/cm(2)/year versus CS free patients 0.013±0.004 g/cm(2)/year; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001. There was no effect of VD/Ca supplementation on BMDL. The prevalence of low BMD was 55%. Duration of disease was the only independent predictor of low BMD. The BMDL was reduced by high cumulative dose of CS and improved by combined anti-TNFα/AZA therapy. The supplementation with recommended doses of VD and Ca had no effect on BMDL.
Cholelithiasis and nonalcoholic fatty liver disease (NAFLD) share the same risk factors. The aim ... more Cholelithiasis and nonalcoholic fatty liver disease (NAFLD) share the same risk factors. The aim of our study was to explore the relationship between these two conditions and to identify independent predictors of both diseases in a cohort of patients with metabolic risk factors. Consecutive patients with metabolic risk factors referred to the outpatient clinic during a one-year period were included. Cholelithiasis was defined by the presence of gallstones on abdominal ultrasound examination at inclusion or previously performed cholecystectomy. NAFLD was defined by the presence of at least one surrogate marker such as elevated alanine aminotransferase and/or gamma-glutamyl transpeptidase and/or ultrasound signs of fatty liver. Other common liver diseases were thoroughly excluded. The prevalence of cholelithiasis among patients with and without NAFLD was determined and clinical and laboratory parameters were identified as predictors of NAFLD by multivariate logistic regression. In total, 482 consecutive patients were included: mean age 61 years; 61% were women; 52% of patients had more than 2 metabolic risk factors (obesity, type 2 diabetes, hypertension, hypertriglyceridemia, or low HDL cholesterol). NAFLD and cholelithiasis were present in 41% and 34% of all patients, respectively. Significantly higher prevalence of cholelithiasis was found among patients with NAFLD compared with patients without NAFLD (47% vs. 26%, respectively; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In multivariate logistic regression model, type 2 diabetes (odds ratio (OR) = 1.99), BMI above 25 kg/m(2) (OR = 1.78), and cholelithiasis (OR = 1.77) were identified as independent predictors of NAFLD. Fifty six percent of patients with cholelithiasis had NAFLD compared with 33% of patients without cholelithiasis (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Multivariate logistic regression identified age above 50 years (OR = 3.46), NAFLD (OR = 1.92), triglycerides above 1.7 mmol/l (OR = 1.91), BMI above 25 kg/m(2) (OR = 1.84), and total cholesterol concentration (OR = 0.711) as independent predictors of cholelithiasis. In conclusion, patients with metabolic risk factors and cholelithiasis suffer significantly more often from NAFLD compared with the reference group. Cholelithiasis represents an independent risk factor of NAFLD in addition to metabolic risk factors and could be regarded as an additional risk factor of liver damage in patients with NAFLD. Furthermore, NAFLD is an independent risk factor for cholelithiasis and might represent a pathogenetic link between the metabolic syndrome and cholelithiasis.
POSTERS CI 1. 012-1.61, p = 0.039). Multivariate regression analysis showed that CAC score was as... more POSTERS CI 1. 012-1.61, p = 0.039). Multivariate regression analysis showed that CAC score was associated with male sex (OR 2.73), Age (<50 yr reference; 50-59 yr OR 3.75; 60-69 yr OR 8.42; over 70 yr OR 21.38), diabetes (OR 1.39), hypertension (OR 1.79), current smoker (OR 1.42) and presence of NAFLD (OR 1.36). Conclusions: Patients with NAFLD are at high risk of coronary atherosclerosis regardless of individuals traits of metabolic syndrome and classical cardiovascular risk factors. Detection of NAFLD should alert to the existence of an increased cardiovascular risk.
European Journal of Gastroenterology & Hepatology, 2014
We report here an unusual case of delayed hypersensitivity reaction in a young woman with ulcerat... more We report here an unusual case of delayed hypersensitivity reaction in a young woman with ulcerative colitis after the first administration of infliximab (IFX). The patient developed severe serum-sickness-like reaction, and her anti-IFX antibody titer increased rapidly after a single infusion of IFX. The possible reason for the delayed hypersensitivity reaction to a single IFX exposure might be the presensitization of the patient by murine antigens as she had been keeping mice and hamsters as pets for several years.
European Journal of Gastroenterology & Hepatology, 2011
Background Patients with ulcerative colitis and Crohn's colitis have increased risk of colorectal... more Background Patients with ulcerative colitis and Crohn's colitis have increased risk of colorectal cancer. Current screening endoscopy protocols based on white light endoscopy (WLE) and random biopsies are laborious and of uncertain sensitivity. Novel endoscopic techniques include chromoendoscopy (CE) and confocal laser endomicroscopy (CLE).
Uploads
Papers by Martin Huorka