[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, 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; · 2.05 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; · 2.05 Impact Factor
[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. · 2.05 Impact Factor