Tamás Molnár

University of Szeged, Algyő, Csongrád, Hungary

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Publications (165)524.61 Total impact

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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.
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    ABSTRACT: Treatment of Crohn's disease (CD) by infliximab (IFX) has been associated with the induction of antinuclear (ANA) and anti-double strand DNA (dsDNA) autoantibodies and in some studies the formation of dsDNA antibodies was associated with lupus-like syndromes. The aims of this study were to analyse the relationship between the development of ANA and dsDNA antibodies during anti-tumor necrosis factor (TNF)α therapy and the clinical efficacy or adverse outcome in patients with inflammatory bowel disease (IBD). Data of 96 CD patients (age at presentation: 25.1 years, folow-up: 5 years, males/females 43/53) treated with anti-TNFα for at least one-year were analyzed. Records of a total of 198 one-year treatment cycles were collected and levels of autoantibodies were determined at induction and after one-year treatment periods. The majority of CD patients had ileocolonic (67.4%) and complicated disease (B2-B3: 72.6%) with perianal lesions (63.2%). At any time ANA or dsDNA positivity was 28.6% and 18%. Elevated level of ANA at induction or during anti-TNFα therapy was not associated with treatment efficacy or development of adverse outcomes. In contrast, treatment efficacy (dsDNA positivity no/partial response vs. remission: 68.5% vs. 31.5%, P=0.003) was inferior and adverse outcomes were more frequent in patients with dsDNA positivity during the anti-TNFα therapy in both univariate analysis and in logistic regression models (OR efficacy: 4.91, 95%CI: 1.15-20.8; OR adverse outcome: 3.81,95%CI 1.04-13.9). Our data suggest that development of dsDNA during biological therapy may be associated with suboptimal treatment efficacy and adverse outcomes in CD patients.
    Journal of gastrointestinal and liver diseases: JGLD 06/2013; 22(2):135-140. · 1.86 Impact Factor
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    ABSTRACT: OBJECTIVES:Luminal serine-proteases lead to increased colonic paracellular permeability and visceral hypersensitivity in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Other proteases, namely cysteine-proteases (CPs), increase airway permeability by digesting epithelial tight junction proteins. In this study, we focused on constipation-predominant IBS (IBS-C) and we aimed to (i) evaluate CP levels in two cohorts of IBS patients, (ii) test if IBS-C fecal supernatant (FSN) affects permeability, and visceral sensitivity after repeated administrations in mice, and (iii) evaluate occludin expression in IBS-C colonic biopsies.METHODS:Fecal CP activity was determined using selective substrate and inhibitor (E64). The effect of papain, as positive control, and IBS-C FSN administrations were evaluated on colonic paracellular permeability and mucosal occludin levels in mice and T84 monolayers. Occludin protein levels were evaluated in IBS-C colonic biopsies. Sensitivity to colorectal distension (CRD) was measured after repeated administrations of IBS-C FSN.RESULTS:We found in a subset of IBS-C patients an enhanced fecal CP activity, in comparison with healthy controls and IBS-D patients. CP activity levels positively correlated with disease severity and abdominal pain scoring. This association was confirmed by receiver operating characteristic curve analysis. In mice, repeated application of IBS-C FSN into colon triggered increased permeability, linked to the enzymatic degradation of occludin, and was associated with enhanced visceral sensitivity to CRD. Finally, occludin levels were found decreased in colonic biopsies from IBS-C patients, and IBS-C FSNs were able to degrade recombinant human occludin in vitro. All these effects were abolished by preincubation of IBS-C FSN with a CP inhibitor, E64.CONCLUSIONS:These data suggest that luminal CPs may represent a new factor contributing to the genesis of symptoms in IBS.Am J Gastroenterol advance online publication, 28 May 2013; doi:10.1038/ajg.2013.152.
    The American Journal of Gastroenterology 05/2013; · 9.21 Impact Factor
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    Alimentary Pharmacology & Therapeutics 03/2013; 37(6):654. · 4.55 Impact Factor
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    T Molnár, K Farkas
    Alimentary Pharmacology & Therapeutics 02/2013; 37(4):498. · 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: Colorectal cancers are mostly sporadic; some cases of familial clustering and autosomal dominant conditions are also known to occur. Juvenile polyposis syndrome (JPS) is an autosomal dominant condition caused by the mutation of the SMAD4 or the BMPR1A genes. JPS is characterized by hamartomatous polyps developing in the upper and lower intestine. Contradicting previous studies, many of these polyps can go through malignant transformation.This paper reports the case of a male patient who was continuously treated for juvenile polyposis. During the eighteen years of treatment, more than hundred polyps were endoscopically removed from his gastrointestinal tract. The patient's care was interrupted for eight years due to insufficient compliance. He was subsequently referred to our Department of Gastroenterology in severe clinical condition caused by metastatic colorectal cancer. He died after a short palliative therapy at the age of 31. His first-degree accessible relatives were further examined for juvenile polyposis syndrome. Several gastrointestinal polyps of different histological origin were observed in the deceased patient's brother, who subsequently had to undergo a left lateral hemicolectomy. Genetic analyses revealed mutations of the BMPR1A gene in the clinically affected brother, the brother's daughter, and in the deceased proband's daughter.Indebt genetic analyses helped customize and deliver care to a very specific group of individuals. We were able to identify potential family members on whom preventive care and treatment could be focused and simultaneously prevented unnecessary clinical and invasive procedures on those who were healthy. Furthermore, these analyses helped prevent future unnecessary trauma or distress on the analyzed family.
    Journal of gastrointestinal oncology 12/2012; 3(4):362-8.
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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. · 2.33 Impact Factor
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    ABSTRACT: Biological therapies are supposed to trigger the development of autoimmune diseases. We report a case of a 27-year old woman presenting with drug induced systemic lupus erythematosus (SLE) associated with infliximab therapy. The development of paradoxical inflammation in immune-mediated inflammatory diseases patients treated with anti TNF-α suggests that an unknown inflammatory pathway may be provoked by inhibiting TNF-α. We suppose that in our case a cross reactivity between anti-infliximab antibodies and autoantibodies may lead to the development of TNF-induced immune disease.
    Journal of Crohn s and Colitis 07/2012; · 3.39 Impact Factor
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    ABSTRACT: Surgical Site Infection (SSI) is the third most frequent nosocomial infection, and accounts for 14-16% of all infections. While the treatment of SSI can be very costly, previous results indicated that triclosan may reduce SSI rate. Therefore, we carried out a prospective randomised trial to further evaluate the effect of triclosan after elective colorectal surgery. Seven surgical units in Hungary were involved in a prospective, randomised, multicentric clinical trial to compare triclosan coated (PDS plus®) and uncoated (PDS II®) sutures for abdominal wall closure in elective colorectal surgery. Pre- and perioperative variables were recorded in an online database. The primary aims of the study were to determine the incidence of SSI and the pathogens associated with it, as well as evaluation of additional cost of treatment. 485 patients were randomised. SSI occurred in 47 cases (12.5%), of those 23 (12.23%) from the triclosan group (n = 188) and 24 (12.18%) from the uncoated group (n = 197, p = 0.982). In 13 (27.66%) cases late appearance of SSI was detected, of those 4 patients with triclosan coated suture (8.51%) and 9 patients with uncoated suture (19.15%, p = 0.041). There was no difference between the type of incisions or elective colon and rectal resections in terms of incidence of SSI. Beneficial effect of triclosan against Gram positive bacteria could not be confirmed in our study due to the relatively low number of patients with SSI. Furthermore, triclosan did not influence the incidence of SSI due to Gram negative bacteria. SSI rate decreased by 50% compared to our previous study, however, it was regardless of the use of coated or uncoated PDS loop. Finally, operative factors were more important than patient's risk factors in terms of incidence of SSI. In case SSI developed, delayed discharge from hospital as well as special wound care significantly increased overall cost of treatment.
    Magyar Sebészet (Hungarian Journal of Surgery) 06/2012; 65(3):83-91.
  • International Journal of Colorectal Disease 05/2012; · 2.24 Impact Factor
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    ABSTRACT: BACKGROUND: Ulcerative colitis (UC) is characterized by frequent relapses, with the presence of colorectal inflammation and mucosal lesions. Matrix-metalloprotease 9 (MMP-9) is elevated in colonic biopsies, urine, and blood plasma of UC patients. MMP-9 has been suggested as a predictor of UC in the urine of children; however, 20% of the controls tested positive. So far, fecal MMP-9 levels have never been measured. Our aims were: 1) to compare fecal MMP-9 levels in UC patients to control subjects and a functional gastrointestinal disorder characterized by diarrhea (IBS-D); 2) to test the correlation between UC disease activity and fecal levels of MMP-9; and 3) to correlate fecal MMP-9 levels with a known fecal marker of UC activity, calprotectin. METHODS: UC (n = 47), IBS-D (n = 23) patients, and control subjects (n = 24) provided fecal samples for MMP-9 analysis. In UC patients, disease severity was evaluated by the Mayo score. Fecal MMP-9 and calprotectin levels were measured by enzyme-linked immunosorbent assay and lateral flow assay, respectively. RESULTS: MMP-9 was undetectable or ≤0.22 ng/mL in the feces of all controls and IBS-D patients. In UC patients, fecal MMP-9 levels significantly correlated with the overall Mayo score (P < 0.001), the endoscopic score (P < 0.001), and the serum C-reactive protein levels (P = 0.002). Additionally, in UC patients fecal MMP-9 levels showed a significant correlation with a known disease activity marker, fecal calprotectin (P = 0.014). CONCLUSIONS: These results highlight fecal MMP-9 as a useful tool in the differential diagnosis of diarrheic disorders and in the noninvasive evaluation of disease activity and mucosal healing in UC. (Inflamm Bowel Dis 2012).
    Inflammatory Bowel Diseases 05/2012; · 5.12 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.
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    ABSTRACT: A 19-year-old man with a 1-year history of ulcerative colitis presented with fever, bloody diarrhea and severe dehidration. He was on po.48 mg methylprednisolon and 3 g mesalazine daily, and has recently finished taking chlarythromycin for Campylobacter jejuni infection. On physical examination, no abdominal tenderness was found, but surprisingly, extensive bilateral subcutaneous emphysema was detected in the supraclavicular regions. Laboratory tests proved anaemia, elevated white blood cell count, thrombocyte count and CRP levels. Stool culture was negative. Chest X-ray and CT scan revealed pneumomediastinum and subcutaneous air on the neck spreading to the scapular regions. Besides blood transfusion, iv. cyclosporin therapy was initiated (200 mg/day) along with iv. methylprednisolon (1mg/kg/day) and iv. ceftriaxon (2 g/day). Stool frequency and bloody stools decreased remarkably within one week, and subcutaneous emphysema has resolved. Colonoscopy one week later revealed deep, extensive ulcerations in the transverse and descending colon without any sign of previous perforation. Cyclosporin and methylprednisolon was continued orally. Pneumomediastinum and subcutaneous emphysema in ulcerative colitis are unusual complications, typically linked to retroperitoneal colonic perforation or toxic megacolon, and are extremely rare without preceding endoscopic procedures. Except from two cases in the literature, conservative treatment with iv. antibiotics and steroids failed to save from urgent surgical procedure, resulting in a partial or total colectomy. In our case we were able to avoid urgent surgery by the immediate use of iv. cyclosporin in combination with iv. steroids and antibiotics, while the outcome of the bowel remains questionable in the next few months.
    Journal of Crohn s and Colitis 02/2012; 6(6):717-9. · 3.39 Impact Factor
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    Inflammatory Bowel Diseases 01/2012; 18(10):E1997-8. · 5.12 Impact Factor
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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
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    ABSTRACT: A severe flare-up develops in approximately 15% of patients with ulcerative colitis (UC). It is questionable whether the response to the first parenteral corticosteroid therapy decreases the risk for colectomy. Our aim was to evaluate the association between long-term colectomy rate and the efficacy of steroids in the first few days of the therapy and to assess other predictive factors for colectomy in our patients hospitalized because of the first severe attack of UC. The records of the first hospitalization of a total of 183 UC patients with severe exacerbation were reviewed. Every patient had received parenteral corticosteroid treatment. Colectomy was performed in refractory UC or in the case of intolerable side-effects of the rescue therapy. We compared different laboratory and clinical parameters between patients undergoing colectomy and those who avoided surgery. Clinical response to steroid therapy was achieved in 110 of the 183 patients with acute severe UC; 14.5% of steroid responder patients were operated on during the follow-up period. 39.7% of patients in the steroid-refractory group required either urgent or late colectomy. The overall colectomy rate was 24.6%. Unresponsiveness to intravenous steroid therapy, anemia, and the need for blood transfusion proved to be the major predictors for colectomy. The colectomy rate was 2.5 times higher in our patients with acute severe UC not responding to the intensive steroid therapy, suggesting that the response to the therapy of the first 3-5 days of hospitalization may determine the long-term outcome and colectomy rate in UC.
    Journal of gastrointestinal and liver diseases: JGLD 12/2011; 20(4):359-63. · 1.86 Impact Factor

Publication Stats

993 Citations
524.61 Total Impact Points


  • 2000–2014
    • University of Szeged
      • • First Department of Internal Medicine
      • • Faculty of Medicine
      Algyő, Csongrád, Hungary
  • 1999–2013
    • Semmelweis University
      • First Department of Internal Medicine
      Budapeŝto, Budapest, Hungary
    • VU University Amsterdam
      • Department of Gastroenterology and Hepatology
      Amsterdam, North Holland, Netherlands
  • 2012
    • Aladar Petz County Teaching Hospital
      Pinnyéd, Győr-Moson-Sopron, Hungary
  • 2008
    • University of Debrecen
      Debreczyn, Hajdú-Bihar, Hungary