[Show abstract][Hide abstract] ABSTRACT: Etiological factors of bone metabolism disorders in inflammatory bowel diseases have been the subject of interest of many researchers. One of the questions often raised is vitamin D deficiency. Calcitriol acts on cells, tissues and organs through a vitamin D receptor. The result of this action is the multi-directional effect of vitamin D. The reasons for vitamin D deficiency are: decreased exposure to sunlight, inadequate diet, inflammatory lesions of the intestinal mucosa and post-gastrointestinal resection states. This leads not only to osteomalacia but also to osteoporosis. Of significance may be the effect of vitamin D on the course of the disease itself, through modulation of the inflammatory mechanisms. It is also necessary to pay attention to the role of vitamin D in skeletal pathology in patients with inflammatory bowel diseases and thus take measures aimed at preventing and treating these disorders through the supplementation of vitamin D.
Archives of Medical Science 11/2015; 11(5):1028-32. DOI:10.5114/aoms.2015.54858 · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Magnetic resonance enterography (MRE) is a useful tool in assessing the transmural and extraintestinal lesions in Crohn's disease (CD). However, the influence of anti-tumor necrosis factor (anti-TNF) therapy on MRE features of CD severity remains unknown. The purpose of the study was to assess the short- and long-term changes in MRE features of CD activity in relation to CD clinical course in patients treated with anti-TNF antibodies.
The influence on the most important parameters of CD activity seen in MRE was assessed retrospectively using a validated score. Patients were treated with anti-TNF agents and the clinical, laboratory, and MRE CD activity was estimated at baseline, after the induction therapy and after 1 year of treatment.
71 patients were enrolled in a study. The change in CD clinical activity correlated significantly with fluctuations in MRE activity score (P < 0.0001, r = 0.5 for induction; P = 0.004, r = 0.7 for maintenance anti-TNF therapy, respectively). Bowel wall thickening, mesenteric lymphadenopathy, and fat wrapping with vascular proliferation were MRE parameters which changed significantly both after the induction and maintenance treatment in patients responding to the therapy. The change in MRE activity score was mostly pronounced during the first 3 months of treatment, when compared to the continuation of the therapy till week 52-54 (-6 points vs. -2 points, respectively; P = 0.0008).
Transmural and extraintestinal healing seen in MRE correlates with changes in CD clinical activity during anti-TNF therapy, thus MRE seems to be a useful tool in monitoring the efficacy of biological agents.
[Show abstract][Hide abstract] ABSTRACT: Apoptosis plays an essential role in both physiology and pathology. In the pathogenesis of inflammatory bowel diseases, disturbances of apoptosis also play an important role. Inflammatory cells (for example lymphocytes, granulocytes) in the gut wall are resistant to apoptotic stimuli and they accumulate there causing tissue damage. On the other hand, apoptotic elimination of the enterocytes is enhanced, which leads to the impairment of the gut barrier. The exact mechanisms of these phenomena are still poorly understood and they are still under investigation. The present paper summarises current knowledge in terms of the role of alterations of programmed cell death in the pathogenesis of inflammatory bowel diseases.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Fecal calprotectin is a useful diagnostic marker in the assessment of Crohn's disease (CD) activity. However, the clinical picture of CD is diverse and its phenotypes change with disease duration: in the early phase, an inflammatory activity dominates and, with time, an increasing percentage of patients develop strictures and fistulas. OBJECTIVES: The aim of the study was to assess whether disease duration affects the diagnostic utility of fecal calprotectin measurement in patients with CD. PATIENTS AND METHODS: A total of 150 patients with CD were prospectively enrolled into the study. CD activity was assessed by magnetic resonance enterography by calculating the Simple Enterographic Activity Score for Crohn's Disease. Endoscopic activity was assessed using the Simple Endoscopic Score for Crohn's Disease (SES-CD). The blood levels of inflammatory markers and the fecal calprotectin concentration were assessed using an enzyme-linked immunosorbent assay. Patients were divided into 2 subgroups depending on CD duration: less than 10 years and 10 years or longer from the diagnosis. RESULTS: Patients with longer disease duration had lower inflammatory CD activity assessed by biochemical, endoscopic, and radiographic tests. Fecal calprotectin showed a tendency for lower concentrations in this subgroup (106.5 ±93.2 mg/l vs. 135.7 ±128.8 mg/l; P >0.05). A stricturing or penetrating CD phenotype was observed significantly more often in patients with long-lasting CD (P <0.04). Nevertheless, in both study subgroups, fecal calprotectin was significantly correlated with SES-CD, C-reactive protein levels, and platelet count. CONCLUSIONS: Disease duration and time-dependent changes of the CD phenotype do not affect the diagnostic utility of the fecal calprotectin measurement. Reliability of this noninvasive biochemical method in the assessment of disease activity is similar in all patients with CD; therefore, it may be used independently of the time from diagnosis.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION Fecal calprotectin is a useful diagnostic marker in the assessment of Crohn's disease (CD) activity. However, CD phenotypes change parallelly to the disease duration: with time, inflammatory activity decreases, and more patients develop stricturing and penetrating disease. OBJECTIVES To assess whether disease duration influences the diagnostic utility of fecal calprotectin measurement in patients with CD. PATIENTS AND METHODS 150 patients with CD were prospectively enrolled into the study. CD activity in magnetic resonance enterography was assessed by calculating the Simple Enterographic Activity Score for Crohn's Disease. Endoscopic activity was assessed with the help of the Simple Endoscopic Score for Crohn's Disease (SES-CD). Blood inflammatory markers were assessed together with the estimation of calprotectin concentration in a single stool sample by using the ELISA method. Patients were divided into two subgroups according to CD duration: < 10 years and ≥ 10 years from the diagnosis. RESULTS Patients with longer disease duration had lower inflammatory CD activity assessed by biochemical, endoscopic and radiographic methods. Also fecal calprotectin was lower in this subgroup (106.5±93.2 vs. 135.7±128.8; ns). Patients with long-lasting CD presented stricturing or penetrating CD phenotype significantly more frequently (p<0.04). Nevertheless, in both study subgroups, fecal calprotectin correlated significantly with SES-CD, C-reactive protein and platelets. CONCLUSIONS Disease duration and the time-dependent changes of CD phenotype do not influence the diagnostic utility of the fecal calprotectin measurement in CD. That is why this non-invasive biochemical investigation can be reliably used in all CD patients, independently of when the disease was diagnosed.
Polskie archiwum medycyny wewnȩtrznej 12/2013; 124(1-2). · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION Magnetic resonance enterography (MRE) is believed to be a reliable diagnostic method in assessing small bowel Crohn's disease (CD) activity, however none of the previously proposed quantifying MRE scores has been in use in everyday clinical practice. OBJECTIVES To construct a Simple Enterographic Activity Score for CD (SEAS-CD) and to investigate its diagnostic usefulness. PATIENTS AND METHODS We carried out a retrospective analysis of MRE investigation results in patients with CD, hospitalized in Poznan University Hospital. CD activity was assessed using the SEAS-CD scale, including the most important imaging markers of CD severity. The reference standard was endoscopic assessment using Simple Endoscopic Score for CD (SES-CD). SEAS-CD correlation with endoscopic, clinical and biochemical findings was performed. We also proposed a Global CD Activity Score by summing up colonic SES-CD and SEAS-CD in order to assess the total CD activity. RESULTS Data from 122 patients were analyzed. In the validation group (n=62), a statistically significant correlation between ileal SES-CD and ileal SEAS-CD was noted (p<0.0001; r=0.72). In patients with isolated small bowel CD, there was a statistically significant correlation between SEAS-CD and: CD Activity Index (CDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, albumin concentration and platelet count. In patients with ileocolonic CD, the Global CD Activity Score correlated with CDAI, CRP, ESR, hemoglobin and hematocrit. CONCLUSIONS SEAS-CD is a useful tool in the quantification of small bowel CD activity in MRE. The Global CD Activity Score reflects the total disease activity in patients with ileocolonic CD.
Polskie archiwum medycyny wewnȩtrznej 06/2013; 123(7-8). · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abdominal bloating is one of the most common gastrointestinal symptoms, which very often impairs the health-related quality of life. It can be a part of many different gastrointestinal disorders, but it can also be an isolated phenomenon. In the current work we present the epidemiological and clinical characteristics of abdominal bloating and other diseases in which this symptom often appears.
[Show abstract][Hide abstract] ABSTRACT: Inflammatory bowel diseases belong to a group of chronic inflammatory disorders. These disorders can be treated by using biological therapy, such as TNF inhibitors - TNF-α blockers, which have been in use for several years. Despite growing expertise in using these drugs, the molecular mechanisms which determine their efficiency are still not fully explained. In this paper we present the current status of this topic and we try to indicate its clinical implications.
[Show abstract][Hide abstract] ABSTRACT: From the epidemiological point of view, Leśniowski-Crohn's disease (CD) has become an important medical problem. It is essential to differentiate CD from functional disorders of the gastrointestinal tract, first of all, from irritable bowel syndrome (IBS). There are no simple, non-invasive tests available which could help to identify patients with common symptoms such as abdominal pain or diarrhea who should be referred for further evaluation, including endoscopy.
The aim of this study was to evaluate the diagnostic utility of the assessment of fecal calprotectin concentration in patients with CD.
Stool samples were taken from 31 patients of the Gastroenterology, Human Nutrition and Internal Diseases Department of Poznań Medical University who were diagnosed with CD. Patients suffering from IBS served as the control group. Calprotectin concentration was assessed by means of the immunoenzymatic ELISA method. Serum C-reactive protein (CRP) concentration and blood cell count were determined. The clinical activity of CD was assessed by means of Crohn's Disease Activity Index. An appropriate statistical analysis was performed.
Mean calprotectin concentration in CD group was 32.01 +/- 22.58 mg/l and it was statistically higher (p <0.0003) than among IBS patients. A concentration of 16.01 mg/l had 67.7% sensitivity and 66.7% specificity in distinguishing between CD and IBS. There was a positive correlation between calprotectin concentration and CRP, and negative--with hemoglobin concentration.
The assessment of fecal calprotectin concentration may be useful in differential diagnoses of CD and monitoring patients with CD.
Polskie archiwum medycyny wewnȩtrznej 11/2008; 118(11):622-6. · 2.12 Impact Factor