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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]

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]

(1) Background: Social distancing rules have been widely introduced in the fight against the coronavirus disease 2019 (COVID-19) pandemic. So far, the effectiveness of these methods has not been assessed in the group of inflammatory bowel disease (IBD) patients. (2) Methods: The study included 473 patients with IBD who made 1180 hospital visits from 1 May to 30 September 2020. During each visit, the patients completed a five-step, progressive scale that was developed to assess the degree of social isolation. In parallel, other demographic data were collected and the concentrations of anti-severe acute respiratory coronavirus 2 (SARS-CoV-2) IgG and IgM+IgA antibodies were measured using the ELISA method. (3) Results: The study found a significant correlation between the degree of social distancing and the presence of anti-SARS-CoV-2 antibodies in the groups with the lowest degree of isolation (3 to 5). (4) Conclusions: Maintaining social distancing is an effective method for reducing the spread of SARS-CoV-2 virus among IBD patients. [ABSTRACT FROM AUTHOR]

Introduction: Although the phenomenon of cytokine storm is well described in patients with severe COVID-19, little is known about the role of the immune system in asymptomatic patients, especially in the group with autoimmune diseases, such as inflammatory bowel disease (IBD). Aim: To assess the stimulation of the immune system expressed through the production of cytokines in IBD patients with asymptomatic COVID-19. Material and methods: This is a multi-centre, prospective study in which the concentration of many cytokines (IL-1a, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, IL-23, IFN-γ, TNF-α, TNF-β) was assessed in patients with IBD and asymptomatic SARS-CoV-2 infection diagnosed by serological tests. Results: In the group of patients with a recent SARS-CoV-2 infection, defined as positive antibodies in the IgA + IgM class, a higher percentage of patients with the presence of interleukin (IL) 2 (IL-2) was found. No association with other cytokines or effects of IBD activity or treatment was found. However, the effect of the applied treatment on the concentration of some cytokines was found: a negative association of infliximab, vedolizumab, and prednisone with IL-2, a positive correlation of steroids, thiopurines with IL-10, and in the case of tumor necrosis factor-α (TNF-α), negative with infliximab, and positive with vedolizumab. Conclusions: The increased concentration of IL-2 may result from its regulatory role in inhibiting excessive activation of the immune system; however, considering the studies of patients with severe COVID-19, its role in the initial phase of SARS-CoV-2 infection requires further research. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) represents a diverse variety of chronic inflammatory intestinal conditions. Sexuality is often disturbed in patients with IBD, more often affecting women than men. Many factors seem to contribute to intimacy concerns. The most popular questionnaires used in empirical research around the world are the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. Sexual satisfaction was negatively correlated with depression, anxiety, sexual problems, and illness perceptions. When analysing the problem of IBD, disorders of sexual function should not be ignored. Patients should be screened for psychological diseases and sexual dysfunction, and necessary treatments should be given as soon as possible. By understanding what factors contribute to poor sexual functioning in patients with IBD, we may try to minimise adverse psychosocial events. Screening for sexual disorders should be a part of daily medical practice. [ABSTRACT FROM AUTHOR]

Anemia is the most common extraintestinal manifestation and complication of inflammatory bowel disease (IBD). Its etiology is multifactorial and mostly is a combination of iron deficiency anemia (IDA) and chronic anemia (ACD). Because of its high incidence in patients with IBD and its influence on their quality of life, regular screening is recommended. In case of IDA type of medication and route of administration should be determined by many factors such as general condition of the patient, IBD activity or anemia severity. Intravenous iron supplementation is the preferred route but may be associated with phosphate drop or even severe hypophosphatemia (HP). The mechanism of HP related to the intravenous iron infusions is not clearly known yet, but it might be related to the change of FGF-23 levels. What more not all parenteral forms of iron are equal and some may have a higher risk of HP than others. [ABSTRACT FROM AUTHOR]

Introduction: The biosimilar product Inflectra® has been approved by the European Medicine Agency (EMA) for the same indications as its reference drug, infliximab, based on studies in patients with rheumatic diseases. Thus far, there have not been enough data regarding its efficacy and safety in ulcerative colitis (UC). Aim: To assess the efficacy and safety of the biosimilar product Inflectra® in comparison with its reference biological agent (Remicade®) in rescue therapy in adult patients presenting with severe exacerbation of UC, as well as to evaluate recurrence rate during a 6-month observation after finish of treatment. Material and methods: In a single-centre retrospective study, a cohort of 83 adult patients with severe UC treated at the Department of Gastroenterology with Inflammatory Bowel Diseases Subdivision of the Central Clinical Hospital of MSWiA, Warsaw was investigated. All patients received three induction doses of Remicade® (28 individuals) or Inflectra® (55 individuals) based on the same criteria of the National Health Fund (NFZ) Therapeutic Program (total Mayo score > 6). Activity of the disease was evaluated on the Mayo scale at qualification, after finishing the rescue treatment (after 14 weeks), and after a 6-month observation period. In all patients, sigmoidoscopy was performed at qualification and after induction (after three doses). Results: The studied groups were similar with respect to age and sex distribution, duration of the disease, extent of the disease (left-sided type, pancolitis), additional pharmacotherapy, and smoking. Clinical response following three induction doses was noted in 81% of patients receiving Remicade® compared to 77% receiving the biosimilar product, Inflectra® (NS); while clinical remission was observed in 42% receiving Remicade® and 32% receiving Inflectra® (NS), respectively. Endoscopic remission assessed as 0 on the Mayo scale was achieved in 4 (15%) patients on Remicade® and in 7 (13%) patients on Inflectra® (p = 0.45). Relapse occurred in 68% of all patients, while 51% presented with exacerbation of the disease 3 months after finishing biological treatment. In 93%, exacerbation occurred within 12 months. The recurrence rate was similar in both groups (75% with Remicade®, 64% with Inflectra®, respectively). Side effects occurred with similar frequency in both groups. Conclusions: In the study, it was established that the biosimilar drug (Inflectra®) has a similar efficacy and safety as the reference biological agent (Remicade®), not only in rescue therapy, but also during a 6-month observation period in adult patients with severe UC. Low mucosal healing rate in both groups and high recurrence rate of the disease soon after finishing induction treatment indicate the need for prolonged therapy with infliximab in patients with severe UC. [ABSTRACT FROM AUTHOR]

The properties of butyric acid, and the role it plays in the gastrointestinal tract, have been known for many years. However, the newest research shows that butyric acid still remains a molecule with a potential that has not as yet been fully exploited. The article provides an outline of relevant up-to-date knowledge about butyric acid, and presents the expert position on the clinical benefits of using butyric acid products in the therapy of gastrointestinal diseases. [ABSTRACT FROM AUTHOR]

Introduction: Anaemia is the most common systemic and extraintestinal complication of inflammatory bowel disease (IBD). Its impact on quality of life is significant; hence, it is important for healthcare professionals to manage it correctly. Aim: To assess the knowledge among doctors about the diagnostics and treatment of anaemia in IBD patients. Material and methods: The questionnaire survey was conducted among 169 doctors of different specialties. Eighty-seven (51.5%) of the respondents were gastroenterologists. Results: 97.7% (84) of gastroenterologists and 92.6% (75) of all responders replied that all IBD patients should be monitored for anaemia (p = 0.266); however, only one-third of gastroenterologists knew the exact haemoglobin cut-off level in men with Crohn’s disease. The necessity of monitoring vitamin B12 was indicated by 53.7% (36) of gastroenterologists and by 24.1 % (13) of other specialists (p = 0.002). Nine percent (6) of gastrologists and 3.7% (2) of other specialists screened for folic acid (p = 0.0431). 13.1% (11) of gastroenterologists and 35% (28) of other specialists frequently used iv iron (p = 0.003). 44.1% (26) of gastroenterologists and 52% (26) of other specialists administered between 1000 mg and 1500 mg of iv iron during hospitalization. Only 11.9 % (7) of GI-specialists and 2% (1) of non-GI-specialists administered total doses over 1500 mg (p = 0.155). 71% (62) of gastroenterologists and 73% (60) of all physicians did not observe any adverse events of iv iron. Conclusions: Although the diagnostic approach to anaemia in IBD patients varies among respondents, knowledge of guidelines was slightly better among GI-professionals then among other doctors. [ABSTRACT FROM AUTHOR]

Introduction: Inflammatory bowel disease (IBD) is a chronic disorder of the gastrointestinal tract, which can significantly deteriorate everyday functioning. We are, however, still lacking simple methods to assess the influence of IBD on patients' disability. IBD Disk is a new graphical tool that allows for a quick assessment of the influence of IBD on different aspects of everyday life. Aim: To present the adaptation process of the IBD Disk in Poland. Material and methods: The Polish IBD Working Group together with the Institute of Translational Medicine in Birmingham (United Kingdom) and a professional translational agency performed a translation and re-translation of the Polish version of the IBD Disk. After full agreement was achieved, the final Polish version was accepted. In the next step, its understandability and ease of use was assessed by using a semiquantitative scale (scale from 1 to 10, where "1" means very easy to use, "10" means - very difficult to use). Results: In the initial translation phase, the concordance between translation agency and experts was very high. In the re-translation phase only some stylistic and grammatical corrections were made. In the final step the general assessment of understandability of all items of the tool was high. Moreover, patients with IBD assessed the ease of use of the IBD Disk as very easy (median: 1.5 points, 95% confidence interval: 1.0-2.0). Conclusions: The Polish adaptation of IBD Disk directly reflects the original English version. Thus, it can be further used in the validation process among Polish IBD patients. [ABSTRACT FROM AUTHOR]