Zoltán Szepes

University of Szeged, Algyő, Csongrád, Hungary

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Publications (58)160.11 Total impact

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    ABSTRACT: Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in the recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We dedicate this article for gastroenterologists, surgeons, internists, pulmonologists, specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society. Orv. Hetil., 2014, 155(14), 526-540.
    Orvosi Hetilap 04/2014; 155(14):526-540.
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    ABSTRACT: To assess the endoscopic activity before and after a one-year period of biological therapy and to evaluate the frequency of relapses and need for retreatment after stopping the biologicals in patients with Crohn's disease (CD) and ulcerative colitis (UC). The data from 41 patients with CD and 22 patients with UC were assessed. Twenty-four CD patients received infliximab, and 17 received adalimumab. The endoscopic severity of CD was quantified with the simplified endoscopic activity score for Crohn's disease in CD and with the Mayo endoscopic subscore in UC. Mucosal healing was achieved in 23 CD and 7 UC patients. Biological therapy had to be restarted in 78% of patients achieving complete mucosal healing with CD and in 100% of patients with UC. Neither clinical remission nor mucosal healing was associated with the time to restarting the biological therapy in either CD or UC. Mucosal healing did not predict sustained clinical remission in patients in whom the biological therapies had been stopped.
    World Journal of Gastroenterology 03/2014; 20(11):2995-3001. · 2.55 Impact Factor
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    ABSTRACT: Blastocystis sp. is one of the most common parasites in the human intestinal tract. This infection commonly is accompanied by diarrhoea and abdominal pain, but extraintestinal symptoms, such as skin lesions, may also accompany the disease. In this study, our aim was to assess the frequency, clinical symptoms and skin manifestations of confirmed positive Blastocystis sp. infections. Data of 80 patients with confirmed positive Blastocystis sp. infections were assessed retrospectively. The average age of the patients was 46.3 years of age (with a range between 13 and 85 years of age). The number of female patients was higher than the number of males (48 vs. 32; 60 vs. 40 %). Gastrointestinal and dermatological symptoms and the results of routine biochemical and haematological blood tests of enrolled patients were collected and analyzed. The skin manifestations were analyzed using the data available (including descriptions, photos and histologies). We discovered that 11.25 % of our enrolled patients exhibited skin manifestations associated to Blastocystis sp., mainly on the females. The occurrence of Blastocystis sp. was 6 % in symptomatic patients who required medical attendance in the time period between 2005 and 2013. Of the 80 patients, 73.75 % indicated that they had gastrointestinal symptoms: 40 patients complained of abdominal pain and 17 with blood in their stool, while other symptoms, such as meteorism (15 subjects), weigh loss (8 subjects), perianal pain or itching (6 subjects), passing stool with mucus (5 subjects), vomiting (2 subjects) and fever (2 subjects) were less frequent. The prevalence of abdominal pain in the cohort without skin lesions was higher compared to those patients with skin problems (p = 0.007). The mean value of C-reactive protein showed elevated levels, but eosinophils were within a normal range. In addition, we did not find significant difference in eosinophilia between patients with vs. without skin manifestations. Thus, we suggest that eosinophilia is not an obligatory laboratory finding in protozoon infections, such as Blastocystis sp. In the light of our results, we suggest a stool parasite examination for patients with skin lesions of unknown origin.
    Parasitology Research 02/2014; · 2.85 Impact Factor
  • Alimentary Pharmacology & Therapeutics 02/2014; 39(3):340. · 4.55 Impact Factor
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    ABSTRACT: Introduction The effects of short course of corticosteroids on the metabolic processes and bone formation has not been well studied. Our aim was to compare the efficacy, the side effects and the bone and lipid metabolisms in IBD patients using bolus or conventional tapering of methylprednisolone for 12 weeks. Patients and methods Nineteen IBD patients received intravenous methylprednisolone of 1 mg/kg for 5 days tapered by 4 mg per week. Patients were prospectively randomized in two groups. In “conventional” group (I) steroids were given daily. In “pulse” group (II) weekly doses of steroids were given on special days of the week. The body mass index (BMI) was measured before and after the corticosteroid therapy. Blood samples were collected to assess glucose level, electrolytes, cholesterol and triglyceride levels, inflammatory parameters, cortisol, osteocalcin and crosslaps values. Total body composition analysis was performed at the beginning and at the end of the steroid therapy. Results In Group I, BMI increased, total body bone density decreased significantly at the end of the steroid therapy. Body fat percent showed a tendency to be higher at the end of steroid therapy in Group I. Cholesterol level increased significantly in Group I patients. The decrease in serum cortisol level was more remarkable in Group I vs. Group II after steroid therapy. Less side-effect occurred in Group II vs. Group I. Discussion Our results suggest that bolus tapering of corticosteroids may have more favorable short term outcome than conventional tapering that may revolutionize steroid therapy in IBD.
    Journal of Crohn s and Colitis 01/2014; · 3.39 Impact Factor
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    ABSTRACT: Introduction: Tumor necrosis factor-alpha inhibitors are increasingly used in the treatment of severe Crohn's disease. Aim: The aim of the authors was to assess retrospectively the short and long term efficacy of tumor necrosis factor-alpha inhibitors in fistulising Crohn's disease. Method: Responses to therapy was determined using Crohn's Disease Activity Index, Perianal Disease Activity Index, the rate of complete fistula closure and the additional surgical procedures during biological therapy. Results: After 12 weeks the perianal activity was decreased in more than 80% of the cases, and the complete remission rate was about 60%. After one year of therapy about one third of the patients had fistula closure, but after cessation of the biological therapy recurrence of fistulas was detected in every second patient. In most cases additional immunosuppressive therapy was necessary during biological treatment. During the one-year therapy period additional surgical treatments were performed in 45% of patients; seton insertion and abscess drainage were the most frequent procedures. Conclusions: Tumor necrosis factor-alpha inhibitor therapy is effective in the treatment of perianal Crohn's disease, however, additional immunosuppressive drugs and rectum sparing surgical procedures were necessary during the one-year treatment period. Because of the high rate of fistula recurrence, long term tumor necrosis factor-alpha treatment may be useful. Orv. Hetil., 154(49), 1943-1948.
    Orvosi Hetilap 12/2013; 154(49):1943-8.
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    ABSTRACT: Abstract Introduction. Several serious side effects may limit the use of cyclosporine. Cyclosporine has been reported to increase the total cholesterol level; however, the change in serum cholesterol levels before and after cyclosporine therapy has not been examined in ulcerative colitis (UC) patients. The purpose of this article was to compare serum cholesterol levels before and after cyclosporine therapy in patients with refractory UC and to examine the relationship between serum cholesterol levels and other common side effects. Patients and methods. We prospectively assessed serum cholesterol levels in UC patients who had been treated with cyclosporine. Data of 72 patients were analyzed and compared to a control group treated with Infliximab. Results. The average duration of cyclosporine therapy was 9.6 months, and side effects developed in 52 patients. Elevated cholesterol levels were detected in 47.2% of the patients. Serum cholesterol levels were significantly increased during and after discontinuation of cyclosporine therapy compared to the time before use of the drug. However, cholesterol levels measured during cyclosporine therapy were significantly higher compared to the time after its discontinuation (p < 0.001). Patients with drug-related side effects showed higher cholesterol levels after discontinuation of the therapy compared to those who did not experience any adverse events. Conclusions. Our findings suggest that cyclosporine therapy may result in increased serum cholesterol levels even in the long-term, after discontinuation of the therapy. Considering that significantly higher post-therapy cholesterol levels were more common in patients who developed drug-related complications, routine measurement of serum cholesterol may increase the safety of the drug.
    Scandinavian journal of gastroenterology 10/2013; · 2.08 Impact Factor
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    ABSTRACT: Abstract Background. Some of the most important questions relating to the use of biological therapy in inflammatory bowel diseases concern the duration of maintenance therapy. The RASH study revealed that previous use of biological therapy and dose intensification are associated with restarting of biological therapy in Crohn's disease. The aim of the study was to assess the disease course and frequency of relapse of ulcerative colitis (UC) following discontinuation of infliximab in patients with remission and to determine predictive factors for relapse. Patients and methods. Fifty-one UC patients who had achieved clinical remission following 1 year of infliximab therapy and for whom infliximab was then discontinued participated in this prospective observational study. 15.7% of the patients received infliximab before the 1-year period of biological therapy analyzed in the study. Biological therapy was restarted in case of recurrent clinical activity. Data were collected from four Hungarian IBD centers. Results. Thirty-five percent of the patients needed to be retreated with infliximab within 1 year after treatment cessation. Logistic regression analysis revealed that previous biological therapy (p = 0.021) was associated with the need of restarting infliximab. None of the data relating to patients' demographic and clinical characteristics, concomitant therapy and CRP level showed association with the need for restarting biological therapy. Conclusions. Biological therapy was restarted at a median of 4 months after discontinuation in more than every third UC patients who had been in clinical remission following 1 year of infliximab therapy. Response to retreatment with infliximab was favorable in the majority of the patients who relapsed.
    Scandinavian journal of gastroenterology 10/2013; · 2.08 Impact Factor
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    ABSTRACT: Introduction: The exact extent of rectal cancer and regional lymph node involvement are essential for providing the optimal treatment. Aim: The aim of the authors was to evaluate the diagnostic accuracy of endoscopic ultrasonography in routine clinical staging of rectal cancer. Method: Outcomes of endoscopic ultrasonography performed between 2006 and 2012 for rectal cancer staging were retrospectively analyzed. The correlation between the endoscopic and pathological stages was evaluated. Results: In patients without neoadjuvant chemotherapy the sensitivity (75% and 73%) and specificity (74% and 80%) of endoscopic ultrasonography for differentiating T1 and T2 stages (respectively) were high, however, it was significantly decreased in differentiation of T3 stage (58%). A weak association was found in different N stages (45-62%). The diagnostic accuracy of endoscopic ultrasound was reduced significantly after the oncological treatment due to the overevaluation (27%) of the findings. After a relatively short learning curve (30 examinations) high correlation was detected between pT and uT stages. Conclusions: Endoscopic ultrasonography provides great help in staging early rectal cancers. Due to the lower sensitivity in patients receiving neoadjuvant therapy, it is not a useful tool after down-staging. Orv. Hetil., 2013, 154, 1337-1344.
    Orvosi Hetilap 08/2013; 154(34):1337-44.
  • Alimentary Pharmacology & Therapeutics 03/2013; 37(6):654. · 4.55 Impact Factor
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    ABSTRACT: Conventional radiologic imaging (abdominal ultrasound, computer tomography) used in the differential diagnosis of post-hepatic jaundice can frequently provide inaccurate diagnosis. Inflammatory lesions may mimic neoplastic processes and malignancy may be accompanied by perifocal inflammation resulting in histological misdiagnosis. Furthermore, chronic and autoimmune pancreatitis are associated with an increased risk for pancreatic cancer. Radial endosonography has become a markedly important method in the imaging of the pancreas. It has a crucial role in the diagnosis and staging of pancreatic cancer. The authors present three cases where the diagnosis of pancreatic cancer determined by conventional imaging techniques (abdominal ultrasound, computer tomography, endoscopic retrograde cholangiopancreatography) was excluded or confirmed by the radial endosonography. The authors conclude that radial endosonography is an essential complementary method among imaging techniques of the pancreas and in tumor staging. Application of that may prevent unnecessary surgeries, which is obviously useful for patients and cost effective for health care providers. Orv. Hetil., 2013, 154, 62-68.
    Orvosi Hetilap 01/2013; 154(2):62-8.
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    ABSTRACT: BACKGROUND: Some of the most important questions relating to the use of biological therapy in inflammatory bowel diseases concern the duration of maintenance therapy. AIM: To assess the disease course and frequency of relapse of Crohn's disease (CD) following discontinuation of biological therapy, and to determine predictive factors for relapse. METHODS: One hundred twenty-one CD patients who had achieved clinical remission following 1 year of biological therapy and for whom biological therapy was then discontinued participated in this prospective observational study. Eighty-seven CD patients had received infliximab and 34 adalimumab. The definition of relapse was an increase of >100 points in CDAI to at least a CDAI of 150 points. RESULTS: Biological therapy was restarted within 1 year of treatment cessation in 45% of patients. Logistic regression analysis revealed that previous biological therapy (P = 0.011) and dose intensification during the 1-year course of biological therapy (P = 0.024) were associated with the need for and the time to the restarting of biological therapy. Smoking was observed to have an effect that was not statistically significant (P = 0.053). CONCLUSIONS: Biological therapy was restarted a median of 6 months after discontinuation in almost half of Crohn's disease patients in who had been in clinical remission following 1 year of biological therapy. These results suggest that, in the event of the presence of certain predictive factors, biological therapy should probably be continued for more than 1 year by most patients.
    Alimentary Pharmacology & Therapeutics 11/2012; · 4.55 Impact Factor
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    ABSTRACT: Introduction: Inactivated influenza vaccination is recommended yearly for patients with inflammatory bowel disease on immunosuppressive therapy. Aim: The aim of our study was to evaluate the immune response to seasonal influenza vaccination in patients with inflammatory bowel disease treated with immunosuppressants. Patients and methods: Thirty patients were enrolled in this prospective study. Each patient was diagnosed with inflammatory bowel disease and treated with immunosuppressants. Blood samples were obtained from patients before and one month after influenza vaccination (A/California/7/2009(H1N1), A/Perth/16/2009(H3N2) B/Brisbane/60/2008) to assess the pre-and postimmunization antibody titers. Virus-specific antibodies were measured by ELISA. Results: The vaccine acceptance rate was 53.3%. Local adverse effect occurred in 5 patients. Seven patients developed systemic adverse events. Influenza-like symptoms occurred in 2 patients, although their antibody titers failed to increase significantly. Antibodies to influenza viruses were detected in each patient before the vaccination. Conclusion: The results confirmed that each patient had appropriate antibody titer as correlation of protection even before the immunisation. Seroprotection rates were not influenced by the vaccination. The vaccine seemed to be safe. Orv. Hetil., 2012, 153, 1870-1874.
    Orvosi Hetilap 11/2012; 153(47):1870-4.
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    ABSTRACT: BACKGROUND & AIMS. Secondary loss of response is a frequent event occurring during biological therapy. The aim of this study was to assess loss of efficacy in patients with Crohn's disease treated with infliximab or adalimumab for a year. The secondary goals were to identify clinical or laboratory predictors of loss of response. METHODS. Sixty-one Crohn's disease patients achieved remission after the induction therapy and received regular maintenance therapy: 35 of them were on infliximab, 26 on adalimumab therapy. None of the patients treated with infliximab had received previous biological therapy, and 10 of the adalimumab-treated patients were naïve to biological therapy. The data of patients who relapsed and who remained in remission and also the characteristics of infliximab-treated patients and adalimumab-naïve patients were compared. Data were analyzed statistically. RESULTS. Remission was achieved in 70.5%; response was achieved in 29.5% of the patients after induction. Loss of response occurred in 22 of 61 patients after a year of therapy. The proportion of remission after induction was significantly lower in patients who lost response vs. those who remained in remission. More patients with sustained remission received immunosuppressive therapy before and during the biological therapy vs. those with loss of response. Loss of response was significantly more frequent and occurred earlier in adalimumab-naïve patients vs. infliximab-treated patients. CONCLUSION. The need for dose escalation should be calculated in the budget in the majority of patients, especially in adalimumab-treated patients.
    Journal of gastrointestinal and liver diseases: JGLD 09/2012; 21(3):265-9. · 1.86 Impact Factor
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    ABSTRACT: Abstract Objectives. Inflammatory bowel diseases (IBD) have a huge impact on the patients' lives and require continuous medication and long-term medical follow-up. The Short Form Health Survey (SF-36) is a commonly used questionnaire measuring health-related quality of life (HRQOL). Our aim was to evaluate whether HRQOL influences medication adherence and vice versa in IBD patients, and to find relationships between demographic parameters, therapeutic modalities and non-adherence or HRQOL. Patients and methods. Five hundred ninety-two IBD patients treated at six Hungarian tertiary centers were enrolled. Patients completed the SF-36 questionnaire and a medication adherence report scale during their visits. The associations between demographic parameters, HRQOL, different kinds of therapies and non-adherence were analyzed. Results. The most affected dimension was physical functioning and least affected were the social functions. About 42.7% of the patients revealed their HRQOL to be acceptable. About 74.6% of the patients believed that the prescribed medications actually improved their HRQOL. Diarrhea was the most common and most severe symptom during the course of the disease. Non-adherence was reported in 13.4% of the patients. 'Forgetting to take the medication' was the main reason for non-adherence in 67.6% of the cases. Medication adherence was significantly higher among nonsmoker patients, and also in the case of immunomodulator therapy. There was no association between the sum of HRQOL and different subscores and non-adherence. Conclusion. Inflammatory bowel disease is associated with low HRQOL, which is not affected by drug therapy. The impaired quality of life in IBD is mainly influenced by the disease itself.
    Scandinavian journal of gastroenterology 08/2012; 47(11):1298-303. · 2.08 Impact Factor
  • International Journal of Colorectal Disease 05/2012; · 2.24 Impact Factor
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    ABSTRACT: Prospective data collection seems to be essential in evidence-based medicine. Because of the new therapeutic options, the need for standard data collection and testing has significantly increased. In Hungary, a registry for patients with inflammatory bowel disease has already been set up, which makes it possible for clinicians to collect prospective data on their patients. Basic characteristics of the database of patients with ulcerative colitis are presented in this paper. The inflammatory bowel disease registry uses the programme of Microsoft Access database management system. Data are stored in a central server. The incidence of inflammatory bowel diseases has been permanently increasing in Hungary; however, its overall prevalence is still low among the European countries. The frequent administration of immunosuppressive medications (azathioprine and corticosteroids) and their increased doses worsen the estimation of the activity. 1., It would be very useful to gain prospective data from all national centres. This kind of database would be able to give a complete picture regarding the Hungarian therapeutical practice. 2., Medications of patients may alter the clinical value of the laboratory findings in the process of determining the severity of the disease.
    Orvosi Hetilap 05/2012; 153(18):702-12.
  • Inflammatory Bowel Diseases 01/2012; 18(10):E1997-8. · 5.12 Impact Factor
  • László Czakó, Zoltán Szepes, Attila Szepes
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    ABSTRACT: Endoscopic ultrasonography is a relatively new technology that combines the use of flexible fiberoptic endoscopes with high-resolution ultrasound technology. It proved to be highly accurate and useful in the staging of gastrointestinal malignancies, as well as in characterizing the nature of subepithelial lesions and disorders of the pancreaticobiliary system. In this overview the variety of current evidence based diagnostic options of endoscopic ultrasonography are discussed.
    Orvosi Hetilap 01/2012; 153(3):93-101.
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    ABSTRACT: Defective epithelial barrier has been implicated in the pathogenesis of irritable bowel syndrome (IBS) and inflammatory bowel diseases. The aim of this study was to investigate gut permeability in patients with inactive ulcerative colitis (UC) and in patients with IBS. IBS patients of the diarrhea-predominant (IBS-D) and of the constipation-predominant subgroup (IBS-C), patients with inactive UC and healthy subjects were enrolled. Gut permeability was evaluated by measuring 24-hour urine excretion of orally administered (51)Cr-EDTA. Clinical symptoms were evaluated in IBS-D patients and correlated to colonic permeability. There was a significant decrease in the proximal small intestinal permeability in IBS-C patients compared to controls (0.26 ± 0.05 vs. 0.63 ± 0.1%; p < 0.05). Distal small intestinal permeability showed no significant difference in the studied group of patients compared to controls. Colonic permeability of IBS-D and inactive UC patients was significantly increased compared to controls (2.68 ± 0.35 and 3.74 ± 0.49 vs. 1.04 ± 0.18%; p < 0.05, p < 0.001). Colonic permeability of IBS-D patients correlated with stool frequency. Elevated gut permeability is localized to the colon both in IBS-D and in inactive UC patients.
    Digestion 12/2011; 85(1):40-6. · 1.94 Impact Factor