Search

The COVID-19 pandemic caused by SARS-CoV-2 has led to a wide range of clinical presentations, with respiratory symptoms being common. However, emerging evidence suggests that the gastrointestinal (GI) tract is also affected, with angiotensin-converting enzyme 2, a key receptor for SARS-CoV-2, abundantly expressed in the ileum and colon. The virus has been detected in GI tissues and fecal samples, even in cases with negative results of the reverse transcription polymerase chain reaction in the respiratory tract. GI symptoms have been associated with an increased risk of ICU admission and mortality. The gut microbiome, a complex ecosystem of around 40 trillion bacteria, plays a crucial role in immunological and metabolic pathways. Dysbiosis of the gut microbiota, characterized by a loss of beneficial microbes and decreased microbial diversity, has been observed in COVID-19 patients, potentially contributing to disease severity. We conducted a comprehensive gut microbiome study in 204 hospitalized COVID-19 patients using both shallow and deep shotgun sequencing methods. We aimed to track microbiota composition changes induced by hospitalization, link these alterations to clinical procedures (antibiotics administration) and outcomes (ICU referral, survival), and assess the predictive potential of the gut microbiome for COVID-19 prognosis. Shallow shotgun sequencing was evaluated as a cost-effective diagnostic alternative for clinical settings. Our study demonstrated the diverse effects of various combinations of clinical parameters, microbiome profiles, and patient metadata on the precision of outcome prognostication in patients. It indicates that microbiological data possesses greater reliability in forecasting patient outcomes when contrasted with clinical data or metadata. Furthermore, we established that shallow shotgun sequencing presents a viable and costeffective diagnostic alternative to deep sequencing within clinical environments. [ABSTRACT FROM AUTHOR]

Copyright of General Practitioner / Lekarz POZ is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nonsteroidal anti-inflammatory drugs (NSAIDs) show high efficacy in anti-inflammatory and analgesic therapy and are the most widely used drugs worldwide. In addition to their efficacy, the widespread use of NSAIDs has been fostered by their wide availability, especially as some are available without a prescription. Unfortunately, this group of drugs is also fraught with adverse effects, including serious ones. Due to the widespread use of NSAIDs, updated data on this group of drugs is critical for practitioners to make the right therapeutic decisions. Each patient requires individualised therapy because, in the case of NSAIDs, the choice of a specific drug, in relation to the type and nature of pain and potential adverse effects, is very important. Over the years, attempts have been made to develop an algorithm for the selection of NSAIDs according to the risk of developing complications associated with drugs of this group in individual cases, taking into account the so-called, golden mean' of NSAIDs and the knowledge of interactions between some NSAIDs and cardioprotective acetylsalicylic acid. This study is another attempt to summarise this issue. With the current state of knowledge, resulting primarily from the publication of the large PRECISION study, which is limited to only three molecules, there remains the fundamental question of expanding the knowledge to include such commonly used drugs as diclofenac, ketoprofen, meloxicam and etoricoxib. In addition to the results of the PRECISION study, this version includes a study by an expert group on other NSAIDs on the Polish market and presents an algorithm for selecting NSAIDs according to individual gastroenterological and cardiovascular risk. [ABSTRACT FROM AUTHOR]

Introduction: Budesonide MMX® is approved for induction of remission in mild-to-moderate active ulcerative colitis (UC) in adults in whom 5-ASA is not sufficient. There is a lack of data on its effectiveness and safety in clinical practice. Material and methods: The CORE Practice study was a multi-centre prospective, observational study of mild-to-moderate UC-patients treated with Budesonide MMX® 9 mg for up to 8 weeks (induction). Enrolled patients had previously been prescribed Budesonide MMX® 9 mg in accordance with the SmPC within a 5-day time window. The primary endpoint was the percentage of patients achieving a decrease ≥ 3 points in the UCDAI clinical sub-score at the end of the induction treatment. Other endpoints were clinical remission (decrease ≤ 1 in UCDAI clinical sub-score), resolution of symptoms, change in Short Inflammatory Bowel Disease Questionnaire (SIBD-Q) score, treatment satisfaction, and tolerability. This report presents results from the Polish study sites. Results: The data from a Polish subgroup of 181 patients with mild-to-moderate UC were analysed. Clinical improvement ≥ 3 points in the UCDAI at the end of treatment induction was achieved in 63.8% patients. Clinical remission was observed in 55.9% of patients at the end of the induction treatment. Full resolution of symptoms (rectal bleeding = 0 and stool frequency = 0) at the end of the Budesonide MMX® treatment was achieved in 52.5% of patients. Significant improvement in quality of life was seen in mean SIBD-Q total score from 40 points at baseline to 56 points at last assessment (p < 0.001). A treatment satisfaction score of more than 8 out of 10 was observed in 72.9% of patients. One patient discontinued Budesonide MMX® due to an adverse event that was related to the study drug, which counted for less than 1% of patients. Conclusions: The data from the Polish subgroup of the real-life study CORE Practice confirms the clinical efficacy of Budesonide MMX® 9 mg in the majority of patients with active mild-to-moderate UC. Budesonide MMX® was safe and well tolerated. The therapy was satisfactory for patients and showed a beneficial effect on the patients' quality of life. [ABSTRACT FROM AUTHOR]

Introduction: There are many known risk factors for osteoporosis (OST) among patients with inflammatory bowel disease (IBD), one of which is physical activity. Material and methods: The aim of the study is to assess the frequency and risk factors of OST among 232 patients with IBD compared to a group of 199 patients without IBD. The participants underwent dual-energy X-ray absorptiometry, laboratory tests, and completed a questionnaire about their physical activity. Results: It was found that 7.3% of IBD patients suffered from OST. Male gender, ulcerative colitis, extensive inflammation in the intestine, exacerbation of disease, rare physical activity, other forms of physical activity, past fractures, lower levels of osteocalcin, and higher levels of C-terminal telopeptide of type 1 collagen were risk factors for OST. As many as 70.6% of OST patients were rarely physically active. Conclusions: OST is a common problem in IBD patients. OST risk factors differ significantly between the general population and those with IBD. Modifiable factors can be influenced by patients and by physicians. The key to OST prophylaxis may be regular physical activity, which should be recommended in clinical remission. It may also prove valuable to use markers of bone turnover in diagnostics, which may enable decisions regarding therapy. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease has become a global health problem at the turn of the 21st century. The pathogenesis of this disorder has not been fully explained. In addition to non-modifiable genetic factors, a number of modifiable factors such as diet or gut microbiota have been identified. In this paper, the authors focus on the role of nutrition in the prevention of inflammatory bowel disease as well as on the available options to induce disease remission by means of dietary interventions such as exclusive and partial enteral nutrition in Crohn's disease, the efficacy of which is reported to be comparable to that of steroid therapy. Diet is also important in patients with inflammatory bowel disease in the remission stage, during which some patients report irritable bowel disease-like symptoms. In these patients, the effectiveness of diets restricting the intake of oligo-, di-, monosaccharides, and polyols is reported. [ABSTRACT FROM AUTHOR]

Approximately 30% of patients with quiescent inflammatory bowel disease (IBD) meet the diagnostic criteria for irritable bowel syndrome (IBS). The aim of this study was to evaluate the effectiveness of a low-FODMAP diet in patients who meet the diagnostic criteria for IBS whilst in IBD remission. A total of 200 patients in remission of IBD were included in the study. Sixty-five of these patients (32.5%) were diagnosed with IBS according to the R4DQ. On the patients who met the IBS diagnostic criteria, anthropometric measurements, laboratory tests and lactulose hydrogen breath tests were performed. A low-FODMAP diet was introduced for 6 weeks. Of the 59 patients with IBS diagnosed at baseline for whom data were collected at the end of follow-up, after the low-FODMAP intervention IBS-like symptoms were not present in 66.1% (n = 39) (95% CI (53.4%; 76.9%)). The difference between the two groups (with SIBO at baseline (33 of 48 patients) and without SIBO at baseline (6 of 11 patients)) in the low-FODMAP diet's effectiveness was not statistically significant (p = 0.586). The low-FODMAP diet improved the gut symptoms of flatulence and diarrhea. It had no effect on the occurrence of constipation. In IBD patients in remission who meet the IBS criteria, the dietary intervention of a low-FODMAP diet is effective for a reduction in IBS-like symptoms, regardless of the coexistence of bacterial overgrowth. [ABSTRACT FROM AUTHOR]

Copyright of General Practitioner / Lekarz POZ is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Metabolic bone disease is a common disorder, but there is a lack of data on it in patients with inflammatory bowel disease (IBD). Methods: In this prospective, one-centre study, we assessed bone mineral and vitamin D alterations in 187 IBD patients (119 with Crohn's disease (CD) and 68 with ulcerative colitis (UC)). Results: While 81.3% of the patients had vitamin D deficiency, 14.2% of them had a severe deficiency. Elevated serum PTH concentrations were found in 14.9% of the patients. Only in 4.1% of cases was there an elevated level of a serum marker for bone formation (osteocalcin), whereas in 14.4% of cases, the bone resorption marker (CTX) was raised. The concentration of phosphate in urine was higher in the CD than in the UC group (51.20 vs. 31.25; p = 0.003). PTH was negatively associated with vitamin D level. Among the patients receiving corticosteroids, the CTX and CRP median levels were higher (0.49 vs. 0.38; p = 0.013 and 6.45 vs. 2.2; p = 0.029, respectively) compared with the group who did not receive them. Urine phosphate levels were lower (48.60 vs. 26.00; p = 0.005), as were osteocalcin (15.50 vs. 23.80; p < 0.001), and PTH (29.05 vs. 36.05; p = 0.018). Conclusions: Bone mineral alterations were common in patients with IBD, mostly in the CD patients. This may be associated with poor absorption, making CD patients vulnerable to changes in bone mineralization. Vitamin D supplementation remains crucial, especially when taking corticosteroids. [ABSTRACT FROM AUTHOR]

Copyright of General Practitioner / Lekarz POZ is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Gut decontamination could have some benefits in preventing infectious complications in acute pancreatitis (AP). Objectives. To investigate whether the administration of rifaximin could have an impact on the outcomes of AP. Materials and methods. We conducted a retrospective study on 373 patients with a median age of 50 years that were admitted to our Department of Gastroenterology in the years 2001-2016 with a diagnosis of AP. Patients were subclassified according to the revised Atlanta criteria: mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). Thereafter, all the patients were divided into 2 groups: in the 1st group (R0) with MSAP and SAP, patients did not receive rifaximin, and in the 2nd group (R1), in the cases of MSAP and SAP, rifaximin was administered to patients at a dose of 3 x 400 mg (for at least 5 days and up to 7 days). There was no other difference in the treatment between the groups. The median duration of hospital stay, the number of infectious complications and the mortality rate were recorded for both groups. Results. A significant difference was observed between median durations of hospitalization between the groups with (R1) and without (R0) rifaximin treatment (14 days compared to 24 days, p = 0.001) and in the number of patients infected with pancreatic necrosis (7 compared to 1, p = 0.0487). However, there was no statistically significant difference between the R1 and R0 group in terms of mortality rate. Conclusions. The results indicate that rifaximin seems to be a promising novel therapeutic option in MSAP and SAP. [ABSTRACT FROM AUTHOR]

Endoscopy is a procedure used for diagnostic and therapeutic purposes, which requires proper preparation. Patients with diabetes mellitus are particularly predisposed to inadequate cleansing for endoscopy due to slowing bowel movements, dietary preparation restrictions, glucose reduction, and the resulting symptoms of hypoglycaemia. So far, no comprehensive guidelines of preparation for endoscopic examinations for patients with these metabolic disorders have been developed. Considering the number of patients who may be subjected to colonoscopy and the possible effects of suboptimal preparation for the examination, the lack of such recommendations seems to be a significant gap in the healthcare system. The article reviews the literature on the above topic. [ABSTRACT FROM AUTHOR]

Copyright of General Practitioner / Lekarz POZ is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Perianal fistulas in Crohn’s disease (CD) are a major problem. In majority of patient, inflammation involves the rectum. Perianal fistulas in CD pose a diagnostic and therapeutic challenge due to severe symptoms and worse prognosis compared to cryptogenic fistulas. The accurate diagnosis is crucial for an effective treatment of CD-related perianal fistulas, and the following should be determined: anatomy of the fistula, possible strictures and inflammation of the alimentary tract, including the rectum and the anal canal. Treatment of fistulas might be challenging and requires cooperation between the colorectal surgeon and the gastroenterologist. The combination of surgical and pharmacological therapy is more effective than surgical or pharmacological therapy alone. In conservative treatment, aminosalicylates or steroids have little significance. In everyday practice, antibacterial chemotherapeutics, antibiotics and thiopurines are applied. The most effective are TNF-neutralizing antibodies, i.e. infliximab (IFX), adalimumab (ADA) and certolizumab (CER). Surgical management can be urgent including drainage. Elective procedures include dissection of the fistula (simple fistula) or more complex interventions such as mucosal flap or ligation of the intersphincteric portion of the fistula. Surgical interventions can be enhanced using the video-assisted anal fistula treatment (VAAFT) or negative-pressure therapy. In extreme cases, creation of a stoma may be necessary. Also, tissue glues or so-called plugs may be applied in managing perianal fistulas. The use of stem cells seems promising, i.e. application of multipotent non-hematopoietic stem cells around the fistula in order to induce immunomodulation and wound healing. [ABSTRACT FROM AUTHOR]

The pancreas has dual functions, endocrine and exocrine, that complement each other and work closely together, contributing to the digestion, absorption, and metabolism of foods. More than a decade ago, it was demonstrated that pancreatic exocrine insufficiency occurs in a significant number of patients with diabetes mellitus. Diabetes mellitus affects virtually every organ system in the body, and the degree of organ involvement depends on the duration and severity of the disease, as well as other co-morbidities. Gastrointestinal side effects include pancreatopathy, small intestinal bacterial overgrowth, oesophageal dysmotility, gastroesophageal reflux disease, gastroparesis, neuropathy, and nonalcoholic fatty liver disease. [ABSTRACT FROM AUTHOR]

Introduction: When a patient is admitted to a hospital for acute pancreatitis (AP), the day of the week on which the admis-sion occurs may influence the outcome of care. The link between reduced weekend staffing practices and outcomes for patients hospitalised for AP, however, has been inadequately studied.Aim: To evaluate the relationship between weekend admission and AP outcome. Material and methods: One hundred and twenty-six patients were prospectively included, assessed according to the revised Atlanta criteria, and observed until discharge or death. Weekend and weekday admissions were compared in terms of severity, aetiology, length of hospital stay, and in-hospital mortality. Results: Patients were divided into two groups according to the timing of admission (weekday, n = 99, 78.6%; or weekend, n = 27, 21.4%). AP was considered severe in 33 (26.2%) patients, moderately severe AP in 37 (29.4%) patients, and mild in 56 (44.4%) patients. No significant differences were found with regard to the distribution of AP severity between the two groups. The impact of weekend admission was not significant for aetiology or for the length of hospital stay (median of 9 vs. 10 days). In-hospital mortality rates were not significantly different for weekday and weekend admissions.Conclusions: Patients admitted for hospitalisation during a weekend received the same level and quality of care at the facility under study as AP patients admitted during the week. Additionally, the rate of favourable outcomes for patients admitted during the weekend was found to be similar to the outcomes of patients admitted on a weekday. [ABSTRACT FROM AUTHOR]

Perirectal fistulas in the course of Crohn's disease (CD) constitute an important problem in this group of patients. They are observed in a vast majority of patients with involvement through colorectal inflammation. Perirectal fistulas in CD present a great diagnostic and therapeutic challenge due to the intensified clinical symptoms and worse prognosis than in the case of crypt originating fistulas. The condition for implementation of effective treatment of perirectal fistulas in the course of CD is correct diagnosis, defining the anatomy of fistulas, presence of potential stenoses and inflammation in the gastrointestinal tract. Treatment of these fistulas is difficult and requires close cooperation between the colorectal surgeon and the gastroenterologist. The combination of surgical and pharmacological treatment has higher efficacy compared to surgical treatment or pharmacotherapy alone. In conservative treatment, aminosalicylates and steroids are of minor importance, while chemotherapeutics, antibiotics and thiopurines find application in daily clinical practice. TNF-a neutralizing antibodies such as infliximab (IFX), adalimumab (ADA) or certolizumab (CER) prove to be the most effective. Surgical treatment may be provided as ad hoc; in this case drainage procedures are recommended, usually with leaving a loose seton. Planned procedures consist in the excision of fistulas (simple fistulas) or performing more complex procedures, such as advancement flaps or ligation of the intersphincteric fistula tract Surgical measures can be complemented by the use of video technology (video-assisted anal fistula treatment VAAFT) or vacuum therapy. In extreme cases, it may be necessary to create the stoma. Treatment of perirectal fistulas includes adhesives or so-called plugs. High hopes may be associated with the introduction of stem cells into clinical practice, which is the administration of non-hematopoietic multipotent cells to the fistulas to induce the phenomenon of immunomodulation and tissue healing. [ABSTRACT FROM AUTHOR]

Copyright of Palliative Medicine / Medycyna Paliatywna is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Periodontitis is a major risk factor of systemic diseases with inflammatory etiology. Numerous studies have established the connection between periodontal condition and diabetes, but there are no reports in the literature on the relationship between periodontitis and other pancreas conditions. The activity of pancreatic enzymes is an important parameter of pancreatic damage, and is also a diagnostic marker of acute and chronic pancreatitis, and the bleeding index determines the periodontitis activity. To date, the periodontal status in both of the above-mentioned conditions has not been examined. Objectives. The objective of the study was to provide a clinical evaluation of oral cavity hygiene and the condition of periodontal tissues in patients diagnosed with pancreatic adenocarcinoma or chronic pancreatitis and in the control group, and to assess the correlation between the activity of periodontitis and the concentration of glycated hemoglobin HbA1c, lipase activity and pancreatic amylase in serum from the examined groups. Material and methods. The serum activity levels of amylase, lipase and HbA1c concentration were correlated with periodontitis activity markers in patients diagnosed with chronic pancreatitis (n = 41), pancreatic cancer (n = 29) and in the control group (n = 50). Results. In the group with chronic pancreatitis, we have found a positive association between the bleeding on probing (BOP) and the amylase activity (r = 0.64) as well as the lipase (r = 0.62; p < 0.05). The patients diagnosed with pancreatic cancer evinced a higher value of the inflammatory response index, namely 1.51, than the other studied groups (H = 24.94; p = 0.01). Patients diagnosed with chronic pancreatitis evinced the highest periodontitis activity indices: BOP: 62.53% (H = 61.31; p = 0.01) and probing depth (PD): 4.14 ±0.89 mm (H = 22.43; p < 0.0001). Conclusions. The study showed that periodontitis in patients with pancreatic cancer is independent of the state of oral hygiene. In the group of patients with chronic pancreatitis, the observed positive correlation between the bleeding index and the enzyme activity suggests interaction between the examined diseases. [ABSTRACT FROM AUTHOR]

The article presents the discussion on great interest among IBD patients. Topics include receiving regular in-person appointments with a full medical examination, laboratory tests, and a dietician consultation; and clinical improvement being observed before mucosal healing and consistent with the study results.