Wojciech Marlicz

Publications of Wojciech Marlicz

• [Irritable bowel syndrome--irritable bowel or irritable mind?].

  Authors: Wojciech Marlicz, Iwona Zawada, Teresa Starzyńska

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 01/2012; 32(187):64-9.

  Irritable bowel syndrome (IBS) is one of the most common disorders of gastrointestinal tract, affecting significant number of western population. The characteristic features are chronic and(or)Irritable bowel syndrome (IBS) is one of the most common disorders of gastrointestinal tract, affecting significant number of western population. The characteristic features are chronic and(or) recurrent abdominal pain and discomfort associated with changes in the bowel habit with or without bloating. According to Rome Criteria III there is an improved focus on the intestinal transit time which allows for better diagnosis and characterization of patients either with diarrhea, constipation predominant or mixed type IBS. Patients with IBS also frequently manifest various symptoms related to central nervous system (CNS) as depression or personality disorders. In this review we present current knowledge concerning etiopathogenesis of IBS with emphasis on the role of microbiota and describe promissing profilatic and treatment modalities with anti-biotics and probiotics capable to modulate microbiota and gut-brain axis. Most recent studies concerning clinical efficacy of antibiotic rifaximin and probiotic strain Lactobacillus plantarum 299v in symptom prevention (reduction) of this common gastrointestinal disorder are briefly described.

• Complement system activation and endothelial dysfunction in patients with age-related macular degeneration (AMD): possible relationship between AMD and atherosclerosis.

  Authors: Anna Machalińska, Miłosz P Kawa, Wojciech Marlicz, Bogusław Machaliński

  Acta ophthalmologica. 11/2011;

  Age-related macular degeneration (AMD) shares several pathological and epidemiological similarities with systemic atherosclerosis (AS). First, an association between AS and AMD is apparent from theAge-related macular degeneration (AMD) shares several pathological and epidemiological similarities with systemic atherosclerosis (AS). First, an association between AS and AMD is apparent from the analyses of the histological and biochemical structure of atherosclerotic plaques in the vascular walls and retinal drusen, the hallmark of AMD. Second, there is considerable evidence implicating endothelial dysfunction in the pathogenesis of both disorders, and cellular oxidative stress appears to be a common denominator underlying this process. Moreover, there are observations that the complement system (CS) triggering inflammatory response contributes to the onset and advancement of both diseases. The CS plays a role in the generation of drusen and neovascularization in AMD as well as in vascular endothelium activation, cell damage and ultimately atherosclerotic plaque formation in the course of systemic arteriosclerosis. It is widely recognized that both AMD and AS are not only related to local stimulation of the CS, but also result in its systemic activation. In addition, a specific Y402H polymorphism of the complement inhibitor factor H has been found to be associated with the incidence of both AMD and AS. Here, we propose a linking hypothesis between CS activation, endothelial dysfunction and the pathogenesis of two common and age-related pathological processes, AS and AMD. We also discuss the potential therapeutic value of pharmacological modulation of CS activation in these disorders.

• Minimal hepatic encephalopathy does not impair health-related quality of life in patients with cirrhosis: a prospective study.

  Authors: Ewa Wunsch, Barbara Szymanik, Michał Post, Wojciech Marlicz, Marta Mydłowska, Piotr Milkiewicz

  Liver international : official journal of the International Association for the Study of the Liver. 08/2011; 31(7):980-4.

  Minimal hepatic encephalopathy (HE) is a serious complication of cirrhosis; however, the impact of minimal HE on health-related quality of life (HRQoL) remains controversial. The Psychometric HepaticMinimal hepatic encephalopathy (HE) is a serious complication of cirrhosis; however, the impact of minimal HE on health-related quality of life (HRQoL) remains controversial. The Psychometric Hepatic Encephalopathy Score (PHES) remains a 'gold standard' for the assessment of minimal HE, but its results clearly differ between studied populations. We studied the effect of minimal HE on patient HRQoL. Eighty-seven consecutive cirrhotic patients were included. All patients underwent clinical and psychometric evaluation at the same day. Ten subjects with overt HE confirmed with West Haven criteria were excluded from the study, thus 77 patients were finally analysed. Patients with minimal HE were identified on the grounds of altered PHES. HRQoL was assessed by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ). Normative reference data for PHES were established from a cohort of 305 healthy Polish subjects. Twenty-nine (37.7%) patients were diagnosed with minimal HE. When patients with and without minimal HE were compared, HRQoL was not significantly different in none of the SF-36 and CLDQ domains. Minimal HE does not affect HRQoL.

• Nodular regenerative liver hyperplasia as a complication of azathioprine-containing immunosuppressive treatment for Crohn's disease.

  Authors: Wojciech Błogowski, Wojciech Marlicz, Andrzej Smereczyński, Małgorzata Lawniczak, Agnieszka Lewosiuk, Teresa Starzyńska

  Immunopharmacology and immunotoxicology. 06/2011; 33(2):398-402.

  Nodular regenerative liver hyperplasia (NRH) is a very rare but potentially severe complication of thiopurine-containing immunosuppressive therapy for autoimmune disorders, organ transplantation,Nodular regenerative liver hyperplasia (NRH) is a very rare but potentially severe complication of thiopurine-containing immunosuppressive therapy for autoimmune disorders, organ transplantation, and/or oncological treatment. Here we report a case of a 40-year-old female patient with Crohn's disease and genetic hypercoagulability disorder-factor V Leiden, who in the course of azathioprine immunosuppressive treatment for inflammatory bowel disease developed NRH, which was clinically manifested by thrombocytopenia and delicate hepato-splenomegaly. Moreover, her endoscopic examination of upper gastrointestinal tract demonstrated esophageal varices. Genetic analysis revealed heterozygous genotype (*1/*3A) of thiopurine S-methyltransferase (TPMT), a key enzyme of thiopurines' metabolism, which results in lower activity of TPMT enzyme, thereby making our patient more susceptible to azathioprine-related hepato and myelotoxicity development. Treatment was started with the immediate cessation of azathioprine therapy, and administration of propranolol as primary prophylaxis for bleeding from esophageal varices. Currently (3 years after diagnosis) remission of Crohn's disease is achieved, however, progression of features of portal hypertension is observed. Propranolol administration is continued and the patient is constantly monitored in our Department. Our Case Study highlights the clinical difficulties and challenges associated with diagnosing of azathioprine-induced NRH, as well as, supports previous observations that hypercoagulability disorders and abnormal TPMT activity may contribute to NRH development.

• [Probiotics in chronic liver diseases].

  Authors: Ewa Wunsch, Wojciech Marlicz, Piotr Milkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 12/2010; 29(174):390-4.

  Recent studies have shown that bacterial intestinal dysbiosis, frequently seen in patients with advanced liver cirrhosis may play an important role in the development of serious complications of thisRecent studies have shown that bacterial intestinal dysbiosis, frequently seen in patients with advanced liver cirrhosis may play an important role in the development of serious complications of this condition. The use of probiotics in this context is an attractive idea because of their ability to modulate intestinal flora, improve gut barrier, and their immunomodulatory and anti-inflammatory properties. Both animal and preliminary human studies have demonstrated efficacy of probiotics in reducing infection, hemodynamic disturbance, improving hepatic encephalopathy, parameters of liver function and histology in patients with liver disease. Probiotics are thought to be safe in this group of patients, nonetheless in view of a few studies reporting serious adverse effects in critically ill or immunosupressed patients, caution must be exercised once they are used.

• Critical flicker frequency fails to disclose brain dysfunction in patients with primary biliary cirrhosis.

  Authors: Ewa Wunsch, Michał Post, Krzysztof Gutkowski, Wojciech Marlicz, Barbara Szymanik, Marek Hartleb, Piotr Milkiewicz

  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 11/2010; 42(11):818-21.

  Recent studies suggest that stage-independent symptoms of primary biliary cirrhosis (PBC) such as chronic fatigue are a consequence of structural and functional abnormalities of the brain. CriticalRecent studies suggest that stage-independent symptoms of primary biliary cirrhosis (PBC) such as chronic fatigue are a consequence of structural and functional abnormalities of the brain. Critical flicker frequency (CFF) is a psychophysiological modality analysing function of cerebral cortex. To analyse the usefulness of CFF in detection of brain dysfunction in patients with PBC. Fifty-one (37 non-cirrhotic/14 cirrhotic) patients with PBC were included. Control group consisted of 31 matched healthy individuals. Fatigue and health-related quality of life (HRQoL) were assessed using Fatigue Impact Scale (FIS) and questionnaire PBC-40. CFF was analysed with HEPAtonorm Analyzer(®). When compared to healthy controls all patients with PBC showed significantly impaired HRQoL in majority of PBC-40 domains and increased fatigue level in physical domain of FIS. No differences in HRQoL and PBC-40 domains were seen, when patients with and without cirrhosis where compared. CFF analysis showed no difference between healthy controls and patients with PBC. CFF did not correlate with PBC-40 and FIS domains. CFF fails to determine brain dysfunction in non-encephalopatic patients with PBC, suggesting that functional efficiency of their cerebral cortex remains unaffected and other central mechanisms are responsible for chronic fatigue in these patients.

• Effects of CYP2C19, MDR1, and interleukin 1-B gene variants on the eradication rate of Helicobacter pylori infection by triple therapy with pantoprazole, amoxicillin, and metronidazole.

  Authors: Barbara Gawrońska-Szklarz, Andrzej Siuda, Mateusz Kurzawski, Dariusz Bielicki, Wojciech Marlicz, Marek Droździk

  European journal of clinical pharmacology. 04/2010; 66(7):681-7.

  Eradication of H. pylori is an important treatment strategy in peptic ulcer patients. Current regimens of eradication consist of proton pump inhibitor (PPI) and two antibiotics. Effects of PPI mayEradication of H. pylori is an important treatment strategy in peptic ulcer patients. Current regimens of eradication consist of proton pump inhibitor (PPI) and two antibiotics. Effects of PPI may depend on their metabolism, and other factors important for the pathophysiology of peptic ulcer disease. Aim of the present study was to evaluate an association of CYP2C19, MDR1, and IL-1B polymorphisms with the eradication rate of H. pylori in Polish Caucasian patients treated with a triple therapy of pantoprazole, amoxicillin, and metronidazole. A total of 139 peptic ulcer patients, positive for H. pylori infection, were treated with triple therapy (pantoprazole + amoxicillin + metronidazole). Subsequently, the patients were divided into two groups (group 1, success, and group 2, failure of eradication after therapy) and genotyped by the PCR-RFLP method for the presence of CYP2C19 variant alleles (*2, *3, and *17), and MDR1 3435C>T and IL-1B +3954C>T polymorphisms. Pantoprazole serum concentrations were measured using the HPLC method. No significant differences in frequency or distribution of CYP2C19 genotypes were found between the two groups of patients (i.e., with successful H. pylori eradication and treatment failure). However, any carrier of defective CYP2C19*2/*2 genotype was found among patients with treatment failure. Similarly, MDR1 and IL-1B genotypes were found to be significantly associated with the success or failure of H. pylori eradication. Univariate and multivariate analysis of the genotypes did not reveal any significant association between the genotypes and H. pylori eradication. Pantoprazole concentrations differed significantly, and were the highest in patients with defective allele CYP2C19*2 carriers and lowest in hyperactive genotype homozygotes CYP2C19*17/*17. The results suggest that the CYP2C19 genotype contrary to MDR1 and IL-1B genotypes may have an impact on the efficacy of H. pylori eradication in peptic ulcer patients treated with pantoprazole in Polish Caucasian peptic ulcer patients administered pantoprazole, amoxicillin, and metronidazole.

• [64-slice computer tomography for diagnostics of the small bowel: computer tomography enteroclysis].

  Authors: Błazej Richter, Anna Walecka, Ewa Gabrysz-Trybek, Wojciech Marlicz, Teresa Starzyńska, Michał Rać

  Annales Academiae Medicae Stetinensis. 01/2010; 56(1):28-35.

  Radiologic imaging of the small bowel is the method of choice because other methods are of limited availability. Computer tomography (CT) enteroclysis is the leading modern method for diagnosticRadiologic imaging of the small bowel is the method of choice because other methods are of limited availability. Computer tomography (CT) enteroclysis is the leading modern method for diagnostic imaging of the small intestine. It combines the advantages of conventional small bowel infusion with those of abdominal CT and can serve to disclose a wide range of small bowel pathologies. 101 patients underwent CT enteroclysis at the Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University in Szczecin. The procedure of CT enteroclysis is described starting from patient preparation and infusion technique to the scanning protocols. The results served to characterize the patients, establish indications and contraindications to CT enteroclysis, and reveal common errors of the method. Preliminary findings bring to light the considerable usefulness of CT enteroclysis. Other methods like ultrasound, MRI, conventional enteroclysis, or capsule endoscopy can be complementary in special cases.

• [Recurrent variceal bleeding in a patient with portal and splenic vein thrombosis secondary to complex thrombophilia]

  Authors: Małgorzata Ławniczak, Joanna Raszeja-Wyszomirska, Wojciech Marlicz, Andrzej Białek, Anna Wiechowska-Kozłowska, Jerzy Lubikowski, Maciej Wójcicki, Teresa Starzyńska

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2008; 25(146):150-2.

  Thrombophilia in adults is one of main causes of portal vein thrombosis. Esophageal and gastric varices, ascites and hypersplenism are well known complications of portal hypertension. There areThrombophilia in adults is one of main causes of portal vein thrombosis. Esophageal and gastric varices, ascites and hypersplenism are well known complications of portal hypertension. There are controversial issues on the management, especially anticoagulant therapy and surgical treatment of these patients. We present a 42-years old woman with a history of three acute coronary episodes suffering from recurrent variceal bleeding due to portal and splenic vein thrombosis in the course of myeloproliferative disorder and protein C deficiency. It was 10 months delay of diagnosis. She was successfully treated with medical and surgical treatment (esophageal stapler transection, cardial devascularization, and splenectomy). In the paper we discuss complexity of diagnosis and surgical treatment.

• [Non invasive markers of non-alcoholic steatohepatitis]

  Authors: Joanna Raszeja-Wyszomirska, Joanna Miezyńska-Kurtycz, Wojciech Marlicz, Małgorzata Ławniczak, Piotr Milkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2008; 25(146):166-70.

  Non-alcoholic steatohepatitis (NASH) is a part of the spectrum of non-alcoholic fatty liver disease (NAFLD), which can progress to hepatic cirrhosis and end-stage liver disease or hepatocellularNon-alcoholic steatohepatitis (NASH) is a part of the spectrum of non-alcoholic fatty liver disease (NAFLD), which can progress to hepatic cirrhosis and end-stage liver disease or hepatocellular carcinoma (HCC). Its pathogenesis is associated with insulin resistance (IR) and the metabolic syndrome. Hepatic steatosis has also been considered an early marker of IR. It is now accepted that NASH is a multistep process with a prominent role for IR, where oxidative stress and cytokines retain a central role. Markers for predicting NAFLD with advanced fibrosis are needed. Once considered irreversible, liver fibrosis is now recognized a dynamic process with significant prospects for remission. The liver biopsy is still a gold standard in assessment of liver fibro-inflammatory activity in the injured liver, but has its own limitations: invasiveness, small tissue sample and inter- and intra-observer error. The lack of non-invasive tests limits the ability of monitoring progression of hepatic fibrosis and response to treatment. Therefore, clinical trials focused on finding of new non-invasive diagnostic tools giving possibilities of frequent, more accurate and reproducible assessment of hepatic fibrosis are constantly conducted.

• [Non-alcoholic fatty liver disease--new view]

  Authors: Joanna Raszeja-Wyszomirska, Małgorzata Lawniczak, Wojciech Marlicz, Joanna Miezyńska-Kurtycz, Piotr Milkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 07/2008; 24(144):568-71.

  Non-alcoholic fatty liver disease (NAFLD) covers a wide spectrum of liver pathology--from steatosis alone, through the necroinflammatory disorder of non-alcoholic steatohepatitis (NASH) to cirrhosisNon-alcoholic fatty liver disease (NAFLD) covers a wide spectrum of liver pathology--from steatosis alone, through the necroinflammatory disorder of non-alcoholic steatohepatitis (NASH) to cirrhosis and liver cancer. NAFLD/NASH is mostly related with visceral adiposity, obesity, type 2 diabetes melitus (DM t.2) and metabolic syndrome. Pathogenetic concepts of NAFLD include overnutrition and underactivity, insulin resistance (IR) and genetic factor. The prevalence of NAFLD has been estimated to be 17-33% in some countries, NASH may be present in about 1/3 of such cases, while 20-25% of NASH cases could progress to cirrhosis. NAFLD is now recognized as one of the most frequent reason of liver tests elevation without clinical symptoms. Insulin resistance is considering as having a central role in NAFLD pathogenesis. In hepatocytes, IR is related to hyperglycaemia and hyperinsulinaemia, formation of advanced glycation end-products, increased free fatty acids and their metabolites, oxidative stress and altered profiles of adipocytokines. Early stages of fatty liver are clinically silent and include elevation of ALT and GGTP, hyperechogenic liver in USG and/or hepatomegaly. Among clinical symptoms, abdominal discomfort is relatively common as well as chronic fatigue. NAFLD/NASH is not a benign disease, progressive liver biopsy have shown histological progression of fibrosis in 32%, the estimated rate of cirrhosis development is 20% and a liver--related death is 12% over 10 years. No treatment has scientifically proved to ameliorate NAFLD or to avoid its progression. The various therapeutic alternatives are aimed at interfering with the risk factors involved in the pathogenesis of the disorder in order to prevent the progression to end-stage liver disease. The most important therapeutic measure is increasing insulin sensitivity by an attempt to change a lifestyle mostly by dieting and physical activity in order to loose weight. The most used agent is metformin, the others are under controlled trials or their effectiveness is low. NASH is not a common indication for liver transplantation because of the older age distribution of patients and high prevalence of comorbidity, related to metabolic syndrome. Recurence of NASH in the grafted liver is also a relatively frequent complication.